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116'-AIADocument G702" -1992
<br />Application and Certificate for Payment
<br />TO OWNER: City of Elk River
<br />13065 Orono Parkway NW
<br />Elk River, MN 55330
<br />FROM Terra General Contractors
<br />CONTRACTOR: 21025 Commerce Blvd Ste 1000
<br />Rogers MN 55374
<br />Code: 421-4-2310-4520
<br />PROJECT: 20-705 FIk River Fire Station #3 APPLICATION NO: 20-705-015 Distribution to:
<br />PERIOD TO: April 30, 2022 OWNER:
<br />CONTRACT FOR: General Construction ARCHITECT:
<br />VIA BKV Group CONTRACT DATE: October 19. 2020
<br />ARCHITECT: 222 N 2nd St, #101 PROJECT NOS: 120-705 1 CONTRACTOR:
<br />Minneapolis, MN 55401 FIELD: Q
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Application is made for payment, as shown below, in connection with the Contract.
<br />AIA Document G703'11, Continuation Sheet, is attached.
<br />1, ORIGINAL CONTRACT SUM................................................................................ $6,898,246.00
<br />2, NET CHANGE BY CHANGE ORDERS................................................................. $0.00
<br />3. CONTRACT SUM TO DATE (Line 1 ± 2)............................................................ $6,898,246M
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ................. $6,157,717,89
<br />5. RETAINAGE:
<br />a. 5.00 % of Completed Work
<br />(Column D + E on G703)
<br />b,. 0 % of Stored Material
<br />(Column F on G703)
<br />$307,885.89
<br />$0.00
<br />Total Retainage (Lines 5a * 5b or Total in Column I of G703) ................. $307,885.89
<br />6. TOTAL EARNED LESS RETAINAGE................................................................... $5,849,832.00
<br />( Line 4 Less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............. $5,590,447.41
<br />(Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE ...................... .... ............................ I ............. .... $259 384.59
<br />9, BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />$1,048,414.04
<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 />$0.00
<br />$0.00
<br />TOTALS
<br />$0.00
<br />$0.00
<br />NET CHANGES by Change Order
<br />S0.00
<br />OTHER: 0
<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 from tV Owner, and that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By: Date: "S S 7-021
<br />State of: MinAsota L___11
<br />County of: Hennepin
<br />Subscribed mid sworn to before
<br />me this ay of Z02.?-
<br />Notary ryPu li L. Jensen
<br />My Commission exp s: January 31, 2026
<br />TERESA L JENSEN
<br />Notary Public, State of Minnesota
<br />My Commission Expires
<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 AMOLTNT CERTIFIED.
<br />AMOUNT CERTIFIED...................................................................................... $259,384,5<3
<br />(Attach explanation if amount cen t fred differs from the amount applied. Initial all figures on this
<br />Application and on the Contr"nuatlo Sheet that are changed to conformwith the amount certified.)
<br />ARCHITECT:
<br />By: Date: May 6, 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 right~ 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 Lago,
<br />"G702," and "AIA Contract Documents" are registered trademarks and may not be used without permission. This document was produced by AIA software at 14:12:32 CT on 0510512022 under Order No.2114310719
<br />which expires on 0412412023. 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: (3139ADA45)
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