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#--IAIADocument G702 -1992 Ci of Elk River Publi orks Director Date
<br />Application and Certificate for Payment Code: 420-4-8540-4^
<br />TO OWNER: City of Elk River PROJECT: Elk River Multi -Purpose Facility and APPLICATION NO: 008-9520003308 Distribution to:
<br />Attn: Justin Femrite Lion John Weicht park PERIOD T0: OWNER:
<br />13065 Orono Parkway 1000 School Street NW
<br />Elk River, MN 55330
<br />FROM RJM Construction, LLC
<br />CONTRACTOR: 830 Boone Ave N
<br />Golden Valley, MN 55427
<br />Elk River, MN 55330
<br />VIA 292 Design Group, Inc
<br />ARCHITECT: 3533 East Lake Street
<br />Minneapolis, MN 55406
<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 „..„».»..„ ........ »...... „.............................................. S25 772,257.00
<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) .».............. $15,561,863.24
<br />5. RETAINAGE:
<br />a. 4.63 % of Completed Work
<br />(Column D + E on G703) $721,068.53
<br />b. 0 % of Stored Material
<br />(Column F on G703) S0.00
<br />Total Retainage (Lines 5a + 5b or Total in Column I of G703) --- „„»»...... S721.068.53
<br />6. TOTAL EARNED LESS RETAINAGE »,».»..»».».............»....----.„,„„„,»,..»,,.
<br />(Line 4 Less Line 5 Total)
<br />T. LESS PREVIOUS CERTIFICATES FOR PAYMENT ... .„............ »»... »».... „....... „.
<br />(Line.6 from prior Certificate)
<br />CONTRACT FOR: General Construction ARCHITECT:
<br />CONTRACT DATE: CONTRACTOR: ❑
<br />PROJECT NOS: / RJM Construction,
<br />LLC / FIELD: ❑
<br />OTHER: ❑
<br />The undersigned Contractor certifies that to the best of the Contractor's knowledge,
<br />information .and belief the Work coveredby this Application for Payment has been
<br />completed.in accordance with the Contract Documents, that all amounts have been paid
<br />by the Contractor for Work for which previous Certificates for Payment were issued and
<br />payments receivedTNin the Owner, and that current payment shown herein is now due.
<br />CONTRACTO
<br />By: Date:
<br />State of: ,m .tirn
<br />County of: Aan
<br />n
<br />Subscribeswo{nto before
<br />me thisday of k . ZtW
<br />Notary Public:
<br />,� l' RILEY DOUGLAS GARDNER
<br />My Commission expires: Ot*mbl/W Notary Public -Minnesota
<br />$14.840,794.71 ARCHITECT'S CERTIFICATE FOR P
<br />$12,800,579.85
<br />8. CURRENT PAYMENT DUE.......................................................................... $2.040.214.86
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />$11.330 021.69
<br />CHANGE ORDER SUMMARY
<br />ADDITIONS
<br />DEDUCTIONS
<br />Total changes approved in previous months by Owner
<br />S410,520.44
<br />$11,961.06
<br />Total approved this Month
<br />S0.01
<br />$0.00
<br />TOTALS
<br />S410,520.4
<br />$11,961.06
<br />NET CHANGES by Clianae Order
<br />I S398,559.40
<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 />AMOUNTCERTIFIED ............ »..»..»..»»..».„..»....»...„.....„.„...»»„..„,„..».».. $2,040,214.9
<br />(Attach explanation if amount cert fed dffers from 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: Me��.! Y Vim. L 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 />AU1 Document G702TM —1992. Copyright ®1953.1963,1965,1971,1978,1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA°° D"u.meM is protected by U.s:
<br />py Coright Law and International Treaties. Unauthorized reproduction or distribution of this AIAO Data any portion of it; may result in seven chill,and, criminal psnalljes,'and will be prosecuted,
<br />to the maximum extent possibte under the law. This document was produced by MA'software at 10.44:56 ET on 03105/2020 under Order No. 6896726545 which expires on 08/0812020, and Is not for resale.
<br />User Notes: (309ADA62)
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