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AIA <br />Document G7020 -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 />Code: 421-4-2190-4520� � <br />Signature: vt, <br />PROJECT: 20-705 Elk River Fire Station #3 APPLICATION NO: 20-705-001 Distribution to: <br />PERIOD TO: February 28, 2021 OWNER: <br />CONTRACT FOR: General Construction ARCHITECT: <br />VIA BKV Group CONTRACT DATE: October 19, 2020 <br />ARCHITECT: 222 N 2nd St, #101 PROJECT NOS: / 20-705 t CONTRACTOR: <br />MInneapolis, MN 55401 FIELD: ❑ <br />OTHER: ❑ <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Application is made for payment, as shown below, in connection with the Contract. <br />AIA Document G703®, Continuation Sheet, is attached. <br />1.ORIGINAL CONTRACT SUM................................................................................ $6,898,246.00 <br />2. NET CHANGE BY CHANGE ORDERS................................................................. $0.00 <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 t4 Contract Documents, that all amounts have been paid <br />by the Contractor for Work li6r #Inch previous Certificates for Payment were issued and <br />payments received ff the er, and at current payment shown herein is now due. <br />CONTRACTOR: <br />3. CONTRACT SUM TO DATE (Line I ± 2)............................................................ $6,898,246.00 By: % Date: �v 2 <br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ................. $62,754.61 State of: Minnesota <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 />$3J 37.73 <br />$0.00 <br />Total Retainage (Lines 5a+ 5b or Total in Column I of G703) ................. S3,137.73 <br />6. TOTAL EARNED LESS RETAINAGE................................................................... $59,616.88 <br />(Line 4 Less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................ $0.00 <br />(Line 6 from prior Certificate) <br />8. CURRENT PAYMENT DUE.......................................................................... 1 $591616.88 <br />BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) <br />S6,838,629.12 <br />CHANGE ORDER SUMMARY <br />ADDITIONS <br />DEDUCTIONS <br />Total changes approved in previous months by Owner <br />S0.00 <br />$0.00 <br />Total approved this Month <br />$0.00 <br />$0.00 <br />TOTALS <br />%00 <br />$0.00 <br />NET CHANGES by Change Order <br />I $0.00 <br />County of: HennelAn (f <br />Subscribed and sworn to before <br />me thi day of PCr­CJ­�, ZC;Z4 <br />No Teresa L. Jensen <br />My Commis on expires: January 31, 2026 <br />TERESA l JENSEN <br />:q= Notary Public, State of Minnesota <br />3.' My Commission Expires <br />January 31, 2026 <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 />AMOUNT CERTIFIED ........................... ............. .......... .............. I .......... I.......... $59.616.88 <br />(Attach explanation if amount certified di fers 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: Date: 03/04/2021 <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 G7020— 1992. Copyright @ 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. T :e "American nstitute f Architects,"';`1A_., the AIA >ogo; <br />C 0 " aio "AA Contract meats' are registered trademarks an: may or _e used .houi permission, This document was produced by AIA software at 12:22:33 CT on 03/03/2021 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: (3139ADA4C) <br />