4.4. SR 03-16-2020 - Laserfiche WebLink

Home Browse Search

APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 1 PAGES TO OWNER: PROJECT: APPLICATION NO: 1 Distribution to: City of Elk River Elk River Ice Arena & Lion John Weicht Park Facilities X OWNER 13065 Orono Parkway NW 1000 School St NW Inv #30078 X ARCHITECT Elk River, MN 55330 Elk River, MN 55330 PERIOD TO: 02/29/2020 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: 292 Design Group H&B Specialized Products, Inc. 6560 Edenvale Blvd PROJECT NOS: Eden Prairie, MN 55346=2502 CONTRACT FOR: CONTRACT DATE: November 25, 2019 CONTRACTORS APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been 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 herein is now due. 1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line 1 f 2) 4, TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. 5% of Completed Work (Column D + E on G703) b. % 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) 0 $ 96,582.00 $ 96,582.00 35816,00 $ 190.80 $ 3,625.20 $ 3,625,20 $ 92,956.80 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS $0,00 $0,00 NET CHANGES by Change Order $0.00 CONTRACTOR: H Specialized Products Inc By: Date: Gary Schultz, Proj Mgr State of: Minnesota Gs? my s Subscribed and s vornzto before me this 17t �V # . ul Notary Public: lq r _ r e° My Commission pi es: ` 301/21/223 \\' 02/17/2020 y20M aNcor. NOT/\i MINI 6 A My Commission E • Jan. 21 In accordance with the Contract Documents, based on on -site observations and the data 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, the duality 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 antoullt certified differs fi•o»� the a»romlt applied bzitial all figtmes o�1 this Application and o�ltlze Continuation Sheet that are changed to confo»�r lvith the a»ro:nit certified.) ARCHITECT: 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. AIA DOCUMENT G702 •APPLICATION AND CERTIFICATION FOR PAYMENT • 1992 EDITION, AIAO, ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee.