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<br />Document G702 � 1992
<br />City of Elk River Publ'�orks Director
<br />Date
<br />Code: 420-4-8540-4520
<br />Application and Certificate for Payment
<br />TO OWNER: City of Elk River PROJECT:
<br />Attn: Justin Femrite
<br />Elk River Multi -Purpose Facility and
<br />Lion John Weicht Park
<br />APPLICATION NO: 007-9520003307
<br />Distribution to:
<br />13065 Orono Parkway
<br />1000 School Street NW
<br />PERIOD TO:
<br />OWNER ❑
<br />Elk River, MN 55330
<br />Elk River, MN 55330
<br />ARCHITECT: 19
<br />FROM RIM Construction VIA
<br />292 Design Group, Inc
<br />CONTRACT FOR: General Construction
<br />CONTRACT DATE:
<br />CONTRACTOR: ❑
<br />CONTRACTOR: 830 Boone Avenue North ARCHITECT:
<br />3533 East Lake Street
<br />PROJECT NOS: / RJM Construction,
<br />FIELD: ❑
<br />Golden Valley, MN 55427
<br />Minneapolis, MN 55406
<br />LLC /
<br />OTHER : ❑
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Application is made for payment, as shown below, in connection with the Contract.
<br />Continuation Sheet, AIA Document 0703, is attached.
<br />1.ORIGINAL CONTRACT SUM ..,„.„_._...,...»,» $25.772 57.00
<br />2. NET CHANGE BY CHANGE ORDERS,.,.„,...»....„......».........................»....„...... $398,559.40
<br />3. CONTRACT SUM TO DATE (Line 1 t 2)..».».....................».....»»»,.....».» ....... $26.170,816.40
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) .„_ ...„„. ,., S13,419,145.49
<br />5. RETAINAGE:
<br />a. 4.60 % of Completed Work
<br />(Column D + E on 4G703)
<br />h. 0 % of Stored Material
<br />The undersigned Contractor certifies that to the best of the Contractor's knowledge,
<br />information and belief the Work covered by this Application for Payment has been
<br />completed, in •accordance with 'the Contract Documents, thatall amounts .have been paid
<br />by the Contractor for Work for which previous Certificates for Payment were; issued and
<br />payments receive�he,Owner, and that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By:
<br />State of .,", S
<br />County ofx....
<br />Subscribedawoy to
<br />L.-t aay 01 Via,
<br />(Column F on G703) $0.00 Notary Public: )
<br />Total Retainage (Lines 5a + 5b or Total in Column I of G703) ». .„. „„. $617,565.64 MY Commission
<br />6. TOTAL EARNED LESS RETAINAGE ..„....„....._......„,,..,»„„»„,»„».,S 12,800,579.85
<br />(Line 4 Less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT .».»„..„.„.».,..,......_»S9.504;446.21
<br />(Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE .......... ........„......... »........................ .,........... .... S3,296.133.64
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />S 13,370,236.55
<br />CHANGE ORDER SLNIIvIARY
<br />ADDITIONS
<br />DEDUCTIONS
<br />Total changes approved in previous months by Owner
<br />S410,520.4
<br />S11,961.06
<br />Total approved this Month
<br />$0.0
<br />S0.00
<br />TOTALS
<br />$410,520.4
<br />$11,%1.06
<br />NET CHANGES by Change Order
<br />$398,559.40
<br />Date: Z-- !J" Z Q
<br />GMDpJrR
<br />Public 4i!lnesota
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT "y"`"`�
<br />In accordance with the Contract Documents, based on on -site observations and the data
<br />comprising this application, the Architect certifies to the Owner that to the best of the
<br />Architect's knowledge, information and belief the Work has progressed as indicated, the
<br />quality of the Work is in accordance with the Contract Documents, and the Contractor is
<br />entitled to payment of the .AMOUNT CERTIFIED.
<br />AMOUNT CERTIFIED ...„...».„..»„.» ». »,.,,,.»,.,,,.„»»». S3.296.133.64
<br />(Attach explanation if amount certified differs front the amount applied Initial all figures on this
<br />Application and on the Continuation Sheet that are changed to conform with the amount certified)
<br />ARCHITECT:
<br />By Date:
<br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
<br />named herein. issuance, payment and acceptance of payment are without prejudice to any rights of
<br />the Owner or Contractor under this Contract.
<br />AIA Document G702*" —1992. Copyright C 1953.1963,1965,1971,1978.1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAe Document is protected by U.S.
<br />Copyright Law and Irnarnational Treades. Unauthorized reproduction a•r distribution of this AIAs Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted
<br />to the maximum extent passible undar the law. This document was produced by AIA software at 1424:15 ET on OZi0=20 under Order No. 6898725W which expires on 0810802020, and is not for resale.
<br />User Notes:
<br />(389ADA60)
<br />
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