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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) <br />TO (OWNER): RJM Construction PROJECT: Elk River Multi Purpose Facility APPLICATION NO: 2 Distribution to: <br />830 Boone Ave N, _ OWNER <br />Golden Valley, MN 55427 Elk River, MN PERIOD TO: 29-Feb-20 ARCHITECT <br />CONTRACTOR <br />FROM (CONTRACTOR): RAM Construction Services of Minnesota, Inc. OWNER'S PROJECT # 0 _ <br />9937 Goodhue Street NE _ <br />Blaine, MN 55449 VIA (ARCHITECT): 292 Design Group RAM PROJECT # 401132 <br />3533 East Lake Street <br />CONTRACT FOR Waterproofing Minneapolis, MN 55406 CONTRACT DATE: July 11, 2019 <br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made ,AIA Document <br />as shown below, in connection with the Contract. <br />Continuation Sheet, AIA Document G703, is attached. <br />CHANGE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />ADDITIONS <br />DEDUCTIONS <br />Approved <br />this Month <br />$ <br />$ 8,000.00 <br />Number <br />Date Approved <br />1 <br />01/17/2020 <br />TOTALS1 <br />$ - <br />$ 8,000.00 <br />Net Change by Change Orders $ (8,000.00) <br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief <br />the Work covered by this Application for Payment has been completed in accordance with the Contract <br />Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for <br />Payment were issued and payments received from the Owner, and that current payment shown herein is <br />now due <br />By <br />RAM Construction Services of Minnesota, Inc. <br />• <br />Date: <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on on -site observations and the data comprising the <br />above application, the Architect certifies to the Owner that to the best of the Architect's knowledge, <br />1- ORIGINAL CONTRACT SUM <br />$ 39,630.00 <br />2. Net change by Change Orders <br />$ (8,000.00) <br />3. CONTRACT SUM TO DATE (Line 1+/-2) <br />$ 31,630,00 <br />4. TOTAL COMPLETED & STORED TO DATE <br />$ 23,520.00 <br />(Column G on G703) <br />5. RETAINAGE: <br />a. 5% of Completed Work $ 1,176.00 <br />(Column D + E on G703) <br />b. _ 5% of Stored Material $ - <br />(Column F on G703) <br />Total Retainage (Line 5a + 5b or <br />Total in Column I of G703) <br />$ 1,176.00 <br />6. TOTAL EARNED LESS RETAINAGE <br />$ 22,344-00 <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT <br />$ 1221700 <br />(Line 6 from prior Certificate) <br />8 CURRENT PAYMENT DUE <br />$ 10,127,00 <br />9 BALANCE TO FINISH, PLUS RETAINAGE <br />$ 9.286.00 <br />(Line 3 less One,6) �N <br />Subscribed 5 orn �V to this 5 0 �ru R r E %1 - . • u RA <br />NotaryPub'c: - ■ aiy ,s,lic <br />Sole of Minnesota <br />My Commission expires:January 31, 2022 P,. Cumn:!ssion Ex�pii es <br />AMOUNT CERTIFIED 5 <br />(Attach explanation if amount certified differs from the amount applied for.) <br />ARCHITECT: <br />information and belief, the Work has progressed as indicated, the quality of the Work is in accordance with By: Date: <br />the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br />Contractor named herein. Issuance, payment and acceptance of payment are without <br />prejudice to any rights of the Owner or Contractor under this Contract. <br />