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<br />-_"� Document G7021-1992
<br />Code: 421-4-2190-4520
<br />Application and Certificate for Payment
<br />TO OWNER: City of Elk River PROJECT:
<br />20-700 Elk River Public Safety Building
<br />APPLICATION NO: 20-700-017
<br />Distribution to:
<br />13065 Orono Parkway NW
<br />Expansion and Fire Station No. 3
<br />PERIOD TO: January 31, 2022
<br />OWNER:
<br />Elk River, NIN 55330
<br />CONTRACT FOR: General Construction
<br />ARCHITECT:
<br />FROM Terra General Contractors VIA
<br />BKV Group
<br />CONTRACT DATE: October 19, 2020
<br />CONTRACTOR: 21025 Commerce Blvd Ste 1000 ARCHITECT:
<br />222 N 2nd St, #101
<br />PROJECT NOS: / 20-700 /
<br />CONTRACTOR:
<br />Rogers MN 55374
<br />MInneapolis, MN 55401
<br />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................................................................................ $6,290,219.00
<br />2. NET CHANGE BY CHANGE ORDERS................................................................. $78,765.42
<br />3. CONTRACT SUM TO DATE (Line 1 t 2)............................................................ $6,369,984.42
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ................. $6,309,604.73
<br />5. RETAINAGE:
<br />a. 5.00 % of Completed Work
<br />(Column D + E on G703) $47,828.73
<br />b. 0 % of Stored Material
<br />(Column F on G703) $0.00
<br />Total Retainage (Lines 5a + 5b or Total in Column I of G703) ................. $47,828.73
<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 froin the OAner, and that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By: 14AVDate: 1i I `1 ZZ
<br />State of: Minnesot
<br />County of: Hennepin
<br />SubscribeA and sworn to before TERESA L Jl
<br />me this `-- day of Few t. -� zpZ Notary Public, State of i ,fr
<br />My Commission , ...
<br />January 31, 2n�,
<br />Notary Pub ' . e Jensen
<br />My Commission expires: January 31, 2026
<br />6. TOTAL EARNED LESS RETAINAGE................................................................... $6,261,776.00 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 ............................................ $6,255,312.26 comprising this application, the Architect certifies to the Owner that to the best of the
<br />(Line 6 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 />8. CURRENT PAYMENT DUE.......................................................................... 1 $6,463,74 entitled to payment of the AMOUNT CERTIFIED
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6) $107,208.42
<br />CHANGE 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 />$0.00
<br />$0.00
<br />TOTALS
<br />$78,765.42
<br />$0.00
<br />NET CHANGES by Change Order
<br />$78,765.42
<br />AMOUNTCERTIFIED...................................................................................... $6,463.74
<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: Date: 02/10/2022
<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. 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 12:23:53 CT on 02/09/2022 under Order No.1547896054
<br />which expires on 04/24/2022, 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:
<br />(3B9ADA5D)
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