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-'� - 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 />Code: 421-4-2310-4520
<br />PROJECT: 20-705 Elk River Fire Station 43 APPLICATION NO: 20-705-005 Distribution to:
<br />PERIOD TO: .lime 30, 2021 OWNER:
<br />CONTRACT FOR: General Construction ARCHITECT: Z
<br />VIA BKV Group CONTRACT DATE; October 19, 2020
<br />ARCHITECT: 222 N 2nd St, 4101 PROJECT NOS: / 20-705 / CONTRACTOR:
<br />Minneapolis, MN 55401
<br />FIELD:
<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 />3. CONTRACT SUM TO DATE (Line 1 1 2)............................................................ $6,898,246.00
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ................. $1,053,302.72
<br />5. RETAINAGE:
<br />a. 5.00 % of Completed Work
<br />(Column D + E on G703) $52,665.14
<br />I�• 0 % of Stored Material
<br />(Column F on 0703)
<br />$0.00
<br />Total Retainage (Lines 5a + 5b or Total in Column 1 of G703) .......... —... $52,665.14
<br />6. TOTAL EARNED LESS RETAINAGE................................................................... $1,000,637.58
<br />(Litic 4 Less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT .............. 5493,769.40
<br />(Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE........................................................................., 1 $506,968.18
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />$5,897,608.42
<br />CHANGE ORDER SUMMARY
<br />ADDITIONS
<br />DEDUCTIONS
<br />Total changes approved in previous months by Owner
<br />$0.00
<br />$0.00
<br />Total approved this Month
<br />$0.00
<br />$0.00
<br />TOTALS
<br />$0.00
<br />$0.00
<br />NET CHANGES by Change Order
<br />$0.00
<br />OTHER: 0
<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 />payments received f m tl Owner, and that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By: Date: 17IZ4 - 1
<br />State of: Minne to
<br />County of; Hennepin
<br />Subscribed and sworn to b-fareZf
<br />me this
<br />day of lF-
<br />No�Puk:75;s, L, Jensen
<br />Nly Commission expires: January 31, 2026
<br />TERESA L. JENSlEN
<br />Notary public, State of Minnesota
<br />' kE Commission Ex ices
<br />Y P
<br />January 31, 2025
<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...................................................................................... $506,868.18
<br />(Attach explanation if amount certified differsfrom 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: ADate
<br />I IV
<br />07/07/2021
<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 0702e — 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 he used without permission, This document was produced by AIA software at 10:25-57 CT on 0710712021 under Order No. 15478MS4
<br />which expires on 0412412022, is not for resale, is licensed for one-time use only, and may only be used in accordance with the AIA Contract DocumentsO Terms of Service. To report copyright violations, e-mail
<br />copyright@aia.org.
<br />User Notes. (3139ADA63)
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