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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF PAGES TO OWNER: RIM CONST PROJECT: ELK RIVER ICE ARENA APPLICATION NO.: BFXS9211E-000,gAtribution to: 830 BOONE AVE N 1000 SCHOOL STNW PERIOD TO: 12/31/2019 ❑ OWNER GOLDEN VALLEY, MN 55427 ELK RIVER MN PROJECT NOS.: ❑ ARCHITECT FROM CONTRACTOR: Molin Concrete Products Co VIA ARCHITECT: CONTRACT DATA/19/2019 El CONTRACTOR 415 Lilac Street ❑ Lino Lakes, NIN 55014-1005 19-9211 ❑ CONTRACT FOR: C®NTRAC'T®1�'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- L ORIGINAL CONTRACT SUM .................. $ 1,013,283.00 ments received from the Owner, and that current payment shown herein is now due. 2. Net change by Change Orders .. ..... $ 47,642.00 CONTRACTOR: Molin Concrete Products Co 3. CONTRACT SUM TO DATE (Line 1 t 2) .... , ... $ 1,060,925.00 4. TOTAL COMPLETED & STORED TO DATE .. , ... $ 636,555.00 (Column G on G703) 5. RETAINAGE: a. egg_% of Completed Work (Columns D + E on G703) b• % Of Stored Material (Column F on G703) Total Retainage (Line 5a + 5b or Total in Column I of G703) ... $ 31,827.78 21 R77 7R 6. TOTAL EARNED LESS RETAINAGE........ $ 604,727.22 (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) ................. $ 100,787.86 8. CURRENT PAYMENT DUE ................. $ 503,939.36 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 456,197.78 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in 47,642.00 previous months by Owner Total approved this Month 47.642.00 TOTALS 47.642.00 NET CHANGES by Change Order By: Date: ��On State of: MINNESOTA County of: ANOKA Subscribed and sworn to before me this day of Notary Public: My Commission expires: ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising this 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, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ............................... $ (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) ARCHITECT: By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA® • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G702-1992 so®i CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reorodur.Pd_