Laserfiche WebLink
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF PAGES <br />TO OWNER: <br />RJM CONST PROJECT: ELK RIVER ICE ARENA <br />830 BOONE AVE N 1000 SCHOOL ST NW <br />GOLDEN VALLEY, MN 55427 <br />ELK RIVER MN <br />FROM CONTRACTOR: Molin Concrete Products Co VIA ARCHITECT: <br />415 Lilac Street <br />Lino Lakes, MN 55014-1005 <br />CONTRACT FOR <br />APPLICATION NO.: BFXS9211E-00%� tribution to: <br />PERIOD TO: 2/29/2020 ❑ OWNER <br />PROJECT NOS.: ❑ ARCHITECT <br />❑ CONTRACTOR <br />CONTRACT DATW.19/2019 ❑ <br />19-9211 ❑ <br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- <br />�i®NTRA\iTOR'S APPLICATION FOR PAYMENTApplication is made for payment, as shown below, in connection with the Contract. inacorn dancceandlief with thethen onto act Doby this Application for Paymentcuments, that all amounts ha eab been <br />been pad byethee <br />Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- <br />1 ORIGINAL CONTRACT SUM ... ..... , . $ 1 013 283.00 ments received from the Owner, and that current payment shown herein is now due. <br />2. Net change by Change Orders _ ....... $ CONTRACTOR: Molin Concrete Products Co <br />3. CONTRACT SUM TO DATE (Line 1 ± 2) ........ $ 1,060 925.00 <br />4, TOTAL COMPLETED & STORED TO DATE ...... $ 1,048,025.00 <br />(Column G on G703) — <br />5. RETAINAGE: <br />a• % of Completed Work <br />(CA inns D + E on G703) <br />State of: MINNESOTA <br />County of: ANOKA <br />Subscribed and sworn to before <br />52,401.28 me this day of <br />b• % of Stored Material $ <br />(Column F on G703) <br />Total Retainage (Line 5a + 5b or <br />Total in Column I of G703) ....... <br />6. TOTAL EARNED LESS RETAINAGE ............ $ - <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT <br />(Line 6 from prior Certificate) ................. $ 604,727.22 <br />8, CURRENT PAYMENT DUE ................. $ <br />39Q.50 896 <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) $ ._65,301.28 <br />CHANGE ORDER SUMMARY <br />Total changes approved in <br />previous months by Owner <br />Total <br />NET CHANGES <br />Notary Public: <br />My Commission expires: <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <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 <br />is entitled to payment of the AMOUNT CERTIFIED. <br />AMOUNT CERTIFIED .............................. . <br />(Attach explanation if amount certified differs from the amount applied for. Initial <br />ADDITIONS DEDUCTIONS all J.igures on this Application and on the Continuation Sheet that are changed to <br />47,642.00 conform to the amount certified.) <br />ARCHITECT: <br />By: Date: <br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- <br />tractor named herein. Issuance, payment and acceptance of payment are without <br />prejudice to any rights of the Owner or Contractor under this Contract. <br />AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • O • c <br />AVENUE, NW, WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocopying A>A S. co • THE lawsAMEand INSTITUTE the <br />ARCHITECTS, gal NEW YORK <br />�d� m p pyin violates U $. copyright laws and will subject the violator to legal prosecution. G702_1992 <br />CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced_ <br />this Month <br />TOTALS <br />by Change Order <br />