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Document G702` --1992
<br />i rrr`
<br />Application and Certificate for Payment
<br />TO OWNER: City ol'EIk River
<br />13065 Orono Parkway NW
<br />Elk Giver, MN 55330
<br />FROM Terra General Contractors
<br />CONTRACTOR: 21025 Commerce Blvd Ste 1000
<br />Rogers MN 55374
<br />Code: 421�4-2119/0�-4�520 �
<br />PROJECT: 20-700 Elk River Public Safety Building APPLICATION NO: 20-700-016
<br />Expansion and Fire Station No, 3 PERIOD TO: December 31, 2021
<br />CONTRACT FOR: General Construction
<br />VIA BKV Group CONTRACT DATE: October 19, 2020
<br />ARCHITECT: 222 N 2nd St, #101 PROJECT NOS: 120-700 1
<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 G703�, Continuation Sheet, is attached.
<br />1. ORIGINAL CONTRACT SUM................................................................................ $6,290,219,00
<br />2. NET CHANGE BY CHANGE ORDERS................................................................. $78,765.42
<br />3. CONTRACT SUM TO DATE (Line i ± 2)............................................................ $6,368,984.42
<br />4. TOTAL COMPLETED $r STORED TO DATE (Column G on 0703) ................. $6,302,800,79
<br />5. RETAINAGE:
<br />a. 5.00 % of Completed Work
<br />(Column D + E on G703)
<br />b, o % of Stored Material
<br />(Column F on G703)
<br />$47.489.53
<br />$0.00
<br />Total Retainage (Lines 5a + 5b or Total in Column I of G703) ................. $47,488.53
<br />Distribution to:
<br />OWNER:
<br />ARCHITECT:
<br />CONTRACTOR; E
<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 Ceilificates for Payment were issued and
<br />payments received fro the Owner, and that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By: Date:
<br />State of; Minnesolt
<br />County of. Hem pin
<br />Subscribed and sworn to bef re t TERESA L JENSEN
<br />me this day of tAp�� Z072— ,+ Notary Public, State of Minnesota
<br />My Commission €xores
<br />14 January 31, 2028
<br />Nota eresa . Jensen
<br />My Commissio expires: January 31, 2026
<br />5. TOTAL EARNED LESS RETAINAGE................................................................... $6,255,312.26 ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />(Line 4 Less Line 5 Total) In accordance with the Contract Documents, based on on -site observations and the data
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................ $6,239,665,40 comprising this application, the Architect certifies to the Owner that to the best of the
<br />(Line b from prior Certificate) 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 />B. CURRENT PAYMENT DUE I......... 1 $15,646A61
<br />entitled to payment of the AMOUNT CERTIFIED,
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less 'Line 6) $1 13,672.I6
<br />C14ANGE ORDER SUMMARY
<br />ADDITIONS
<br />DEDUCTIONS
<br />Total changes approved in previous months by Owner
<br />$78„765.42
<br />$0.00
<br />Total approved this Month
<br />S0.00
<br />So.00
<br />TOTALS
<br />$78,765.42
<br />SAW
<br />NET CHANGES by Change Order
<br />$78,765A2
<br />AMOUNT CERTIFIED...................................................................................... $15,646.86
<br />(A Hach if arnnrart certified differs from the amount alyVied._ Initial all figures on this
<br />Application and on the Continuation Sheet that are changed to conforrrr with the amount ce)-t f eel.}
<br />ARCHITECT: By: A,Date: 01 /07/2022
<br />I his 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 />Alp Document G70211-1992. Copyright 0 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 16-1.3:35 CT on 01104/2022 under Order No.1547896054
<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: (389ADA5A)
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