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RUI Document G702E -1992 Code: 421-4-2310-4520 Application and Certificate for Payment TO OWNER: Citv of Elk River PROJECT: 20-705 Elk Rover Fire Station ;:3 APPLICATION NO: 20-705-010 Distribution to: 13065 Orono Parkway N%V PERIOD TO: November 30, 2021 OWNER: Elk River, MN 55330 CONTRACT FOR: General Construction ARCHITECT: CONTRACT DATE: October 19,2020 FROM Terra General Contractors VIA BKV Group CONTRACTOR: 21025 Commerce Blvd Ste 1000 ARCHITECT: 222 N 2nd St, #101 PROJECT NOS: 0-705 / CONTRACTOR: Rogers NIN 55374 Minneapolis, MN 55401 FIELD: ❑ OTHER: ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract information and belief the Work covered by this Application for Payment has been AIA Document made f or Continuation Sheet a ow,inattached. completed in accordance with the Contract Documents, that all amounts have been paid b th C Ira t f Ill —A, f - h C rCf t f P t d d h 1.ORIGINAL CONTRACT SUM 2. NET CHANGE BY CHANGE ORDERS ............................................... 3. CONTRACT SUM TO DATE (Line 1 t 2).......................................... 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. 5.00 % of Completed Work (Column D — E on G703) b. 0 % of Stored Material (Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) 6. TOTAL EARNED LESS RETAINAGE ..................... (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ( Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE ................................ 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) y e on c or or r o r w Ic previous e I Ica es or aymen were Issue an $6,898,246.00 payments recei ed from t e Owner, and that current payment shown herein is now due. .00 $0CONTRACTO . S6,898,246.00 By: Date: 12/8/2021 S4,256,845.00 State of: nnesota County of Hennepin — TERESA L JENSEN Subscribed and sworn to fire r. Notary Public, State of Minnesota $212,542.26 me this day of MY Commission Expires -- January 31, 2026 S0.00 Not I eresa L. Jensen S212,842.26 My Commissio expires: January 31. 2026 S4.044,002.74 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data S3,179.410.49 comprising this application, the Architect certifies to the Owner that to the best of the Architects 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 S864,592.25 entitled to payment of the AMOUNT CERTIFIED. S2.854,243.26 CHANGE ORDER SUMMARY ADDITIONS I DEDUCTIONS Total changes approved in previous months by Owner S0.0 $0.00 Total approved this Month 50.0 S0.00 TOTALS S0.01 S0.00 NET CHANGES by Change Order S0.00 AMOUNT CERTIFIED....................................................................._...._........ $864,592.25 (Attach explanation ifamount 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: Date: 12/09/2021 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 G702--1992. Copyright © 1953, 1963, 1965. 1971. 1978. 1983 and 1992 by The American Institute of Architects. AA rights reserved. The -American Institute of Architects,' -AIA,- the AIA Logo, 'G702,' and WA Contract Documents' are registered trademarks and may not be used without permission. This document was produced by AIA software at 08:00:52 CT m 17JO812021 under Order No.1547896054 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 Dowments° Terms of service. To report copyright violations. a -mad copyright@aia.org. User Notes: (3B9ADA5B)