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o -1992 Code: 421-4-2310-4520
<br />&0 Document G702
<br />Application and Certificate for Payment
<br />TO OWNER: City of Elk River PROJECT: 20-705 Elk River Fire Station #3 APPLICATION NO: 20-705-014 Distribution to:
<br />13065 Orono Parkway NW PERIOD TO: March 31, 2022 OWNER:
<br />Elk River, MN 55330 CONTRACT FOR: General Construction
<br />ARCHITECT:
<br />CONTRACT DATE: October 19, 2020
<br />FROM Terra General Contractors VIA BKV Group
<br />CONTRACTOR: 21025 Commerce Blvd Ste 1000 ARCHITECT: 222 N 2nd St, #101 PROJECT NOS: ,`' 20-705 ! CONTRACTOR:
<br />Rogers MN 55374 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................................................................................ S6,898,246.00
<br />2. NET CHANGE BY CHANGE ORDERS ................................................ ............. I... $0.00
<br />3. CONTRACT SUM TO DATE (Line I f 2)............................................................ $6,898,246.00
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ................. $5,884,681.48
<br />5. RETAINAGE:
<br />a. 5.00 ° o of Completed Work
<br />(Column D + E on G703)
<br />b• 0 % of Stored :Material
<br />(Column F on G703)
<br />$294,234.07
<br />S0.00
<br />Total Retainage (Lines 5a+ 5b or Total in Column I of G703) ................. $294.234.07
<br />6. TOTAL EARNED LESS RETAINAGE................................................................... S5,590.447.41
<br />(Line 4 Less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................ S5,247,941.58
<br />(Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE.......................................................................... I S3421505.83
<br />BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />$1,307,798.59
<br />CHANGE ORDER SUMMARY
<br />ADDITIONS
<br />I DEDUCTIONS
<br />Total changes approved in previous months by Owner
<br />S0.001
<br />$0.00
<br />Total approved this Month
<br />$0.001
<br />$0.00
<br />TOTALS
<br />S0.001
<br />$0.00.
<br />NET CHANGES by Change Order
<br />S0.00
<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 frand that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By: Date: 4/5/2022
<br />State of: Minnesota
<br />County of: Hennepin
<br />Subscribed and sworn to before n E
<br />: TERESA L JENSEN
<br />me this 4`--- day of t �Z `= Notary Public, State of Minnesota
<br />r` My Commission Expires
<br />` January 31, 2026
<br />Nota je. Teresa L. Jensen
<br />My Commissi expires: 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 />AMOUNT CERTIFIED...................................................................................... $342,505.83
<br />(Attach explanation if amount certified differs from the amount applied. Initial all figures on this
<br />Application and on the Continuatiovi Sheet that are changed to conform with the amount certified.)
<br />ARCHITECT:
<br />By: Date: 04/08/2022
<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 `A,r erican Iris,'tute or Architects," `AIA.' the AIA € ogo,
<br />d 'AIA Contract uo ume + " a-e €�tcr trademarks and may not be used without permission. This document was produced by AIA software at 07:58:21 CT on 04/05/2022 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 Documentsl Terms of Service. To report copyright violations, e-mail
<br />copyright@aia.org.
<br />User Notes: (3B9ADA62)
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