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- AIA
<br />c Code: 421-4-2190-4520
<br />Document G702 -1992
<br />Application and Certificate for Payment
<br />TO OWNER: City of Elk River PROJECT: 20-700 Elk River Public Safety Building APPLICATION NO: 20-700-013 Distribution to:
<br />13065 Orono Parkway NW Expansion' PERIOD TO: October 31, 2021 OWNER:
<br />Elk River, MN 55330 CONTRACT FOR: General Construction
<br />ARCHITECT:
<br />FROM Terra General Contractors VIA BKV Group
<br />CONTRACTOR: 21025 Commerce Blvd Ste 1000 ARCHITECT: 222 N 2nd St, #101
<br />Rogers MN 55374 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 G703®, Continuation Sheet, is attached.
<br />1. ORIGINAL CONTRACT SUM ................................................. I ...... I. ............... I......
<br />$6,290,219.00
<br />2. NET CHANGE BY CHANGE ORDERS.................................................................
<br />$78,765.42
<br />3. CONTRACT SUM TO DATE (Line 1 f 2)............................................................
<br />$6,368,984.42
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) .................
<br />$6,014,681.07
<br />5. RETAINAGE:
<br />a. 5.00 % of Completed Work
<br />(Column D +E on G703) $300,734.06
<br />b• 0 % of Stored Material
<br />(Column F on G703)
<br />$0.00
<br />Total Retainage (Lines 5a + 5b or Total in Column I of G703) .................
<br />$300,734.06
<br />6. TOTAL EARNED LESS RETAINAGE...................................................................
<br />$5,713,947.01
<br />(Line 4 Less Line 5 Total)
<br />7, LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................
<br />$5,397,835.34
<br />(Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE.......................................................................... $316,111.67
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />$655,037.41
<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 />$78,765.42
<br />$0.00
<br />TOTALS
<br />$78,765.42
<br />$0.00
<br />NET CHANGES by Change Order
<br />$78,765.42
<br />CONTRACT DATE: October 19, 2020 CONTRACTOR:
<br />PROJECT NOS: / 20-700 /
<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 />payments receive om he Owner, and that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By: 4_2Date:
<br />State of: Mi rota
<br />County of: ennepin
<br />Subscribed and sworn to b re ... TERESA L JENSEN
<br />me this Z ay of Z ' o _ Notary Public, State of Minnesota
<br />MY Commission Expires
<br />January 31, 2026
<br />Notary P resa L. Jensen
<br />My Commission a "re
<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 />AMOUNTCERTIFIED............................................................... I ................ I .... 1 $316,111.67
<br />(Attach explanation if amount certified differs 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:al Date: 11 /03/2021
<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 G702®— 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 13:36:17 CT on 10/2912021 under Order No.1547896054
<br />which expires on 04124/2022, 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: (3139ADA62)
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