4.4. SR 03-16-2020 - Laserfiche WebLink

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APPLICATION AND CERTIFICATE FOR PAYMENT (AIA DOCUMENT G702/CMa) TO OWNER: PROJECT: APPLICATION NO: FOUR (4) Distribution to: City of Elk River Elk River Ice Arena & Lion John Weicht Park Facilities OWNER ❑ 13065 Orono Parkway NW 1000 School Street NW PERIOD TO: 02-28-20 Elk River, MN 55330 Elk River, MN 55330 CONSTRUCTION MANAGER ❑ CONTRACT DATE: 07-10-19 VIA CONSTRUCTION MANAGER: ARCHITECT ❑ FROM CONTRACTOR: RJM Construction, LLC PROJECT NO: 0 High Five Erectors II, Inc. CONTRACTOR ❑ 3005 4th Avenue East, P.O. Box 477 VIA ARCHITECT: Shakopee, MN 55379 292 Design Group CONTRACT FOR: Install Steel & Misc. Metals Li CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Application is made for payment, as shown below, in connection with the Contract. Work covered by this Application for Payment has been completed in accordance with the Contract Documents, Continuation Sheet, AIA Document G703, is attached. that all amounts have been paid by the Contractor for Work for wich previous Certificates for Payment were 1. ORIGINAL CONTRACT SUM ............................................ 2. Net Change by Change Orders ........................................ 3. CONTRACT SUM TO DATE (Line 1 ±2)................................. 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. 5% of Completed Work (Column D + E on G703) $ 14,718.60 b. 0% of Stored Material (Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) 6. 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 less Line 6) $ 435,750.00 issued and payments received from the Owner, and that rrent payment shown herein is now due. $ (2,198.15) CONTRACTOR: / $ 433,551.85 B _1 Date: � %� $ 294,372.00 $ 14,718.60 $ 279,653.40 ... $ 216,790.95 $ 62,862.45 $ 153,898.45 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total Changes approved in previous months by Owner $ - $ - Total approved this Month 4,190.00 500.00 6,888.15 CO #1 - PR 2 Lease Space CO #2 - Deduct from Allowance CO #3 - ASI 35 add column/weld plates TOTALS $ 4,690.00 1 $ 6,888.15 NET CHANGES by Change Orders 1 $ (2,198.15) State of: Minnesota County of: Scott Subscribed and sworn to before me this day of bt.0(,f Notary cv - My Commission expires: a I '_71 a—S KIM A STOCK Notary Public - Minnesota My Commission Expires 0113112025 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Construction Manager and Architect certify to the Owner that to the best of their 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. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) CONSTRUCTION MANAGER: ARCHITECT: By: Date: By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.