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APPLICATION AND CERTIFICATION FOR PAYMENT, Construction Manager as Adviser Edition AL4 DOCUMENT G702 TO OWNER: PROJECT: ELK RIVER ICE ARENA & PARK FACILITIES APPLICATION NO: 2 Distribution to: RIM CONSTRUCTION LLC ELK RIVER MN OWNER 930 BOONE AVE NORTIT PERIOD TO: 12/31/2019 CONSTRUCTION MANAGER GOLDEN VALLEY MN 55427 CONTRACT FOR: RCHITECT ONTRACTOR 5TELD FROM CONTRACTOR: CONTRACT DATE: 7/I0/2019 WELLS CONCRETE VIA CONSTRUCTION PO BOX 656 MANAGER: PROJECT NOS:. ALBANY, MN 56307 VIA ARCHITECT: Contract for Bid Package: CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, iu connection with the Contract. Tbc undersigned Contractor certifies that to the best ofthe Contractor's knowledge, information and belief the Work covered by this Application for Payment has been d` Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown berein is now due. I ORIGINAL CONTRACT SUM S 925.000.00 CONTRACTOR: IC p 2. NET CHANGE BY CHANGE ORDERS 3. CONTRACT SUM TO DATE (Line I ± 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. 5% % of Completed Wark (Column D + E on G703) b. 0% % of Stored Material (Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) b. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 nuns Line 6) $ 21,930.45 $0.00 $0.00 S 925,000,00 S 438,609.05 By:%4---- Date State of: MINNESOTA County of STEARNS Subscribed and swo fore we this 17 day of December Notary Public: My Commission expires: 1 j 1 J o a 12/17/19 i C 2019 n Z co � ti M $ 21,930,45 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on an -site observations and the data g $ 416,679,60 comprising the application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, $ 35,149-35 the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. $ 381,529.24 AMOUNT CERTIFIED ..................... $ 381,529.24 $ 508,32140 (Attach explanation if amount certified drffersfrom the amount applied. Initial all figures on this Application and owhe Continuation Sheet that are changed to conform with the amount certifred) CONSTRUCTION MANAGER: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ Total approved this Month TOTALS NET CHANGES by Change Order By: Date: ARCHITECT: (NOTE: If Multiple Prime constrictors are responsible for performing portions of the Project, the Architect's Certification is not required.) By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance ofpayment are without prejudice to any rights of the Owner or Contractor under this Contract. ALA DOCUMENT 3702 - APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION - AIA - 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE, N.W., WASHINGTON, CC 20000-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee.