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<br />=.�•�.� D�cument �1+�� — � 992
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<br />��p�lication an�f �ertificat� for Payment -
<br />TQ �VIINER: ['ity oi� [:lk R��-cr PRDJECT: 2+�-7[lt� t:lk rt���cr Pubii� 5��iciy f;ui141in� APPLICATION HS]: 2u-7t1[s-02(] Ftec❑inage �istri�utinn to:
<br />13C}Ci5 (�1�oi10 P.lrhlt�t3y N1G� i:.r'��af�sinn �i�icl 1=iri 5t<ilia�� Nn. 3 P�RIOD FC1: fi�lr 3�, �f122 aWNER: �
<br />'C1I� Riw�ci, MN 55�3[} C{]NTRACT F[3R: ti4���r:ll C-1111S�CL1[;IIC)tl
<br />ARCNITECT: �I
<br />FR�M "I'erra Cieneral Ls�ntz•actc�rs VIA L�K'�J Cirnu��
<br />CONTRACT4R: Z I{}25 Cnntmci°cr T�lvd 5lc B[if1[) ARCF�ITECT: ?z2 N?�zci S3, #11 [11
<br />kc��crti MiV jj374 �SInnc;�F3��lis, NIN Sj-}fl�
<br />C�7NTRACTaR'S ARPLICATIDN FaR PAYMENT
<br />A�7�SIica[it��� is matic lur E�a)mrcnt, as sl�ott�t� bcic�t4�. in conn�:ctiu�i tt•ill3 ll�e f�a�itrac9.
<br />III/I I)t3C4iC71Cl71 Ci7(13'", ('[�iiti«t�s�sii�n 517cci.. i;: ,rttach.c�3..
<br />�. �RIGINAL CflNTRACT 517M .................�.�.�,�..�..,�.,,,.,,,,,."�.,,�.,,,.,�,,,.,.,..,,,.�,,,.�,..,. SG,29O,21 �).(l[1
<br />2, NET CHANGE BY CHANGE OR��FtS ................................................................. xTh,3bi.4'
<br />3. CUNTRACT 5kJM Tfl DAT� ll.iait I�- ?) ............................................................ 5fi,3fi�+,��+�M1.�}2
<br />4, T�TAL COMPLETED & STORED TO DATE {t'❑I<«���, C� «�� t;7!}3} ,,,,,,,,,,,,,,,,, 5G,337,3'i4,72
<br />5. RfTAfNAGE:
<br />�. S.(1(} °�u c�1� ('orn�rictctl 1V[�ric
<br />(L't�ltotn» T3 .. C cri� ti7fl:i} '�?,iU[7.[1i1
<br />a. {} ��;, c�f 5lare�i Materi.�l
<br />(C'nlu�tz33 I' c��i f;7D3) S{J.{1{}
<br />�T"nlal lieli�iita�;e (Line� Sri +�b oi 'I'olal i�t C:oltu�in I c�l�Ci7{)3j � .............�.. SF.ti(1[l.(1�}
<br />6. FC}1'AL �ARhfEd LESS RETA�NAGE ................................................................... SCi,:�3�4,4�4.72
<br />[Liric � Lc�� Li�ic 7 Tc,talj
<br />7. LESS PREVIOUS CERT�FfGATES FC]R PAYMENT ............................................ tiC�.2h8.1 Cat,.�1�)
<br />[Lir�� l� fi•nitl C�r•inrt'crtitic,itc}
<br />8, GURRENT FAYMEIVT DUE ...�.,........�.� .............�.�............,..........,...............�� X�}fi.717.73
<br />BALANCE Td FIlVISW, IHCLUDING RETAINAGE
<br />�L.inc w lcss Lin�: 6}
<br />ti33,{i99.71Y
<br />C'1-IANt7E UiZDLit SL1h��iviAFt�` Af}E}I"T'Ii1N5 C71;[)t1{°:'C[C)N5
<br />Tntt�! �}�an�,cs �i�zj3rn��cd in �arcG icxis innntE7s �>� f)wncr �74,7[,5.42 S�OIY.I}i3
<br />�'i��t��l �ippr��vcd lhis �4nu19� 50.[.lE �[L[)il
<br />"€'C7T�1LS $7�t.7[i5.42 ��f1l7.Uil
<br />�ICT C`Hh1�C�CS U� Clian rz i�rc�er `�7�i,3b5.42
<br />COhJTRAC7 pAT�: Uctol�cr l9, Zr120
<br />PRQJECT NpS� � 2a-7[�r.i !
<br />C�NTRAGTaR: �
<br />FIELa: Q
<br />QTHER: ❑
<br />Tlic tincici•;;igneti C'oi�trttcttzr certiii�s t�tat io tltc 6�-s1 of tltc C'c�titract[x�''s knt�wlccl�c,.
<br />ir7fc�rmztinn a�ic� �iclicf� thc Wn�•k ic��ercci hy this Applic�titm For Payi�lci�t tias bccn
<br />com2�leted in accc�rclance �vitli lfie Cnntr�ict Dc�cl���7cr�ls, ttiat .ill amc�linfs tia��c P�ccn paid
<br />i�y the L;untr�tclt�r fczr �V��rk for' which previou� L'et'tilicates fc�r i'ayinet�t were issued �i�icl
<br />���y��icnts r°ccci��ccl frt�ti� tt ()wi� �r, a t���it c�irrer�t ��aymcnt shc�wn I�crein is n��v cluc,
<br />CONTRA�TQR: % /�
<br />13��: Date: �j �( ��� `'" �'
<br />S[F]1L' [7I: MIti11�S(7Ca �
<br />Cc�t�ilty cxi`, 1-[�i7ric�ir�
<br />Sillrscril�c�l �tnd s�ti�t�rn in beli,re RYAl�! SCfln` STFtfC10ER
<br />nae this � J'�' ci�fy nP�� -.� aL:k'�vZ MlI� ���
<br />- .I�+�a+y 37. ZtY18
<br />Nc�lary f t�lrlic: ltyrin Slrickci
<br />�1y Cni�im�s5i�ii ex��ircti: Jziniary 31, 2(lZfi
<br />ARCHITECT'S CERT�FICATE F[}R PAYMENT
<br />Ir� accnr<��utcc ��sth th� C'ontract Uc�cttt��cnts, �)e7SCL� (1�1 (111-ti1tL' nI75CYVfltIC131ti anci lfte data
<br />uom�rSsing lE�is a�3pli�atic>>�, the �lrcliitc�t ccrti{tC.S fn tl7c Clwncr t}7�t t�� thc bcst of' tl�r
<br />Archil�;ct'ti kr�o��•ledge, i��lc�nnatio�� ancl belief t1�e 4Vork has F�rogressed as inciicated, lh�
<br />t�t�alit_Y ul�tlie V1�ork is in accc�rdai7ce �4�it1� t:l�e C;nntract C1ocL�nlents, a��cl the C'�ntretetc�r i5
<br />ciiliticd tn l7Eiyn�citt c�1't9�c 11VIOUNT C'�RTII�IED.
<br />AMQUNT CERTIFIEQ .........................................................................�.....,....., S4b,7i 7.7:i
<br />(A1lr�r ir �•.���lrr„�rrr'r,,, i� �r,r,n,r„r ct�rri�iE�r! r(1�/�°rs �•niri 1ftr� pitrr�irAat a{�]3lir•rf. I�rlrirrl rrll.fis;rr�•e•.c rx�r ffais
<br />:l�ry�firc�lrr��� �tr�d rr�r 11ic C'n��firirrc �irjlr 5'i�c�c�! tlrrit crre cl�rr�l,s;cd dn r�riaajr�i•�rt tiviflr tlrc• lf1YfC�iillf L'Y'dYf�lL't�.l
<br />ARCHITECT:
<br />i���: ' r��;�: 08/04/2022
<br />`li3is L'ertiltealr iti 17i71 �3e�nti:�hic. Ti�e AMCIUI�iT CN.I�`I'll�I1:[7 is p�,iy�thlt. niAly I�� tlie ('rartl�,3cliir
<br />nan,cci }rci�in. Issu�inc�c, ��aymciit and ricrc3�tance nl`paymcnt �rc �voti�otit �?ic�tic{ic.c to tiny riblits of
<br />thc ()w�icr nr t'�rontraclnr uiidLr 1l�is C'«ntra4t_
<br />AIq Document G742u— 1992. Copyright �� 7953, 1963, 7965, i971, 1978, 1983 and 1992 hy The American Institule of Flrcf�ikects. AIP ric�f7fs rEserved. The "American instituke af Archi[ects,° "AkA," lhe AIA Lago,
<br />"G7{12," and "AiA ConlracY Documen�s" are registered Irademarks and may not he use�i without perm'rssion, Thfs ciocsrment was praclueec! t�y AEA sot�vuare at 13:34:37 CT an 0$lD312022 under C3rder No.2714310719
<br />wril�l� expires oi7 6Al2d12�23. 1s iiat for resale, fs licensed for one-lime use anRy, and may only he used in accordance wi�h the AfA ContracE 6ocumenls� 7errrss of Service. To report co�yrigh! Wolalions, e-mail
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