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9 AIA .e <br />Document G702® -1992 <br />Application and Certificate for Payment <br />TO OWNER: City of Elk River <br />13065 Orono Parkway NW <br />Elk River, MN 55330 <br />FROM Terra General Contractors <br />CONTRACTOR: 21025 Commerce Blvd Ste 1000 <br />Rogers MN 55374 <br />PROJECT: 20-700 Elk River Public Safety Building <br />Expansion and Fire Station No. 3 <br />VIA BKV Group <br />ARCHITECT: 222 N 2nd St, ##101 <br />MInneapolis, MN 55401 <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Application is made for payment, as shown below, in connection with the Contract. <br />AIA Document G7030, Continuation Sheet, is attached. <br />APPLICATION NO: 20-700-004 <br />Distribution to: <br />PERIOD TO: January 31, 2021 <br />OWNER: <br />CONTRACT FOR: General Construction <br />ARCHITECT: <br />CONTRACT DATE: October 19, 2020 <br />PROJECT NOS: 120-700 / <br />CONTRACTOR: <br />FIELD: ❑ <br />OTHER: ❑ <br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, <br />information and belief the Work covered by 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 />1. ORIGINAL CONTRACT SUM...................................................................I............ $6,290.219.00 payments received fr tl wrier, and that current payment shown herein is now due. <br />2. NET CHANGE BY CHANGE ORDERS................................................................. $0.00 CONTRACTOR: % <br />3. CONTRACT SUM TO DATE (Line 1 f 2)............................................................ $6.290.219.00 By: Date: <br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ................. $1,188,515.04 State of. Minneso <br />5. RETAINAGE: <br />a. 5.00 % of Completed Work <br />(Column D + E on G703) <br />b. 0 % of Stored Material <br />(Column F on G703) <br />County of: Hennepin <br />Subscribed a sworn to be ore TERM L JENSEN <br />me this day of Veef 1r��H �r �Of 0nneiolis <br />w r�r.. <br />Jai. i . V n, 2M <br />Notary ere L. Jensen <br />Total Retainage (Lines 5a + 5b or Total in Column I of G703) ................. $59.425.75 My Commission xpires: January 31, 2026 <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) <br />8. CURRENT PAYMENT DUE ................................ <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) <br />$59,425.75 <br />$0.00 <br />$1,129,089.29 <br />$638.886.64 <br />.............................. 1 $490,202.65 <br />$5.161.129.71 <br />CHANGE ORDER SUMMARY <br />ADDITIONS <br />DEDUCTIONS <br />Total changes approved in previous months by Owner <br />$0.0 <br />$0.00 <br />Total approved this Month <br />$0.0( <br />$0.00 <br />TOTALS <br />S0.0[ <br />$0.00 <br />NET CHANGES by Change Order <br />$0.00 <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 is <br />entitled to payment of the AMOUNT CERTIFIED. <br />AMOUNTCERTIFIED...................................................................................... $490,202.65 <br />(Attach explanation if amount certified diJf ers from the amount applied. Initial all figures on this <br />Application and on the Continual' n Sheet that are changed to conform with the amount certified) <br />ARCHITECT: <br />By: Date: 02/04/2021 <br />IV <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 />AIA Document 07026-1992. 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, <br />'G702.' and "AIA Contract Documents" are registered trademarks and may not be used without permission. This document was produced by AIA software at 15:11:29 CT on 02/02/2021 under Order No.6421824392 <br />which expires on 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 Documents* Terms of Service. To report copyright violations, e-mail <br />copyright@aia.org. <br />User Notes: (3B9ADA50) <br />