4.4. SR 11-16-2020 - Laserfiche WebLink

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® ® Code:421-4-2190-4520 1 A Document G702 - 992 rt'� Application and Certificate for Payment TO OWNER: City of Elk River PROJECT: 20-700 Elk River Public Safety Building APPLICATION NO: 20-700.001 13065 Orono Parkwav NW Expansion and Fire Station No. 3 PERIOD TO: October 13, 2020 Elk River, MN 55330 CONTRACT FOR: General Construction FROM Terra Construction VIA BKV Group CONTRACT DATE: October 19, 2020 CONTRACTOR: 21025 Commerce Blvd Ste 1000 ARCHITECT: 222 N 2nd St, #101 PROJECT NOS: / 20-700 / Rogers MN 55374 MInneapolis, MN 55401 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. AIA Document G7030, Continuation Sheet, is attached. 1.ORIGINAL CONTRACT SUM................................................................................ $6.290.219.00 2. NET CHANGE BY CHANGE ORDERS................................................................. $0.00 3. CONTRACT SUM TO DATE (Line I t 2)............................................................ $6.290,219.00 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ................. $59,952.43 5. RETAINAGE: a. 5.00 % of Completed Work (Column D + E on G703) $2,997.62 b. 0 % of Stored Material (Column F on G703) $0.00 Total Retainage (Lines Sa + 5b or Total in Column I of G703) ................. $2,997.62 6. TOTAL EARNED LESS RETAINAGE................................................................... $56,954.81 (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................ $0.00 (Line 6 from prior Certificate) S. CURRENT PAYMENT DUE.......................................................................... $56,954.81 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $6,233,264.19 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $0.00 $0.00 Total approved this Month $0.00 $0.00 TOTALS SO.00 $0.00 NET CHANGES by Chance Order $0.00 Distribution to: OWNER: ARCHITECT: CONTRACTOR: FIELD: ❑ OTHER: ❑ The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been 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, an4fhq current payment shown herein is now due. CONTRACTOR: By: Date: State of. Minnesota County of: Hennepin Subscribed and sworn to before TERESA L JENSEN me this day of A I�¢k=-�lR StaOs of llrtnesole _ W commisskm Etephes Notary Pu L. Jensen =' 20� My Commission expir3: January 31, 2026 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising this 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 quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED...................................................................................... $56,954.81 (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.) ARCHITECT By; �y Date: 11 /05/2020 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 G7020-1992. Copyright ©1953, 1963, 1965, 1971, 1978. 1983 and 1992 by The American Institute of Architects. All rights reserved. The "American Institute of Architects; "AIA," the AIA Logo, "G702; and "AIA Contract Documents" are registered trademarks and may not be used without permission. This document was produced by AIA software at 12:49:15 CT on 11104/2020 under Order No.6421824392 which expires an 04/24/2021, is not for resale, is licensed for one-time use only, and may only be used in accordance with the AIA Contract Documentsm Terms of Service. To report copyright violations, e-mail copyright@aia.org. User Notes: (3B9ADA54)