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<br />App�rcafi�►rr ana� Certificat�e far Payrnent
<br />Td �W��f�: C'i[v cai L`�k Iti��c�
<br />1 ;{1C;5 [iroz�c� F�ac�kil�ay NW
<br />El�: River. MN 57;30
<br />FRt}�49 'i'�re•a C���3cra1 Cai7tracturs
<br />CONTRACTOR: 2In25 t'ani�ncr�c i31��d Stc lC�[1D
<br />rz{�����s n��r ss�-�-�
<br />PR�JEGT:
<br />VfA
<br />ARCHITECI';
<br />2R}-7[}{1 i�lk f�ivcr I'ul�lic Sal'c.ly f3uilclin�
<br />}aF�arttiinn .i�}c! I i�� :SEatin» k�lc�. 3
<br />�3KV Gro�q�
<br />222 N 2nd �t, `I I Q I
<br />�llru7�•tsE���li5, MN 5]-}U�
<br />C4NTRA�T4R'S A�P�ICATlQN FDR PAYMENT
<br />,1�rFalieatic�n is macic 4i�r pa)��ncnt, :is siro��m licla��, in con�tcciinn wilii ihe C:n�tlract.
<br />��,IA 1)ocuuncnl C�7i}.;'", [.'onlinu:ilinn 4hcel, it allachrd.
<br />1. c7RI�INAL CONTRACT SUM ................................................................................ �r�,2ga,? i��.��a
<br />2. tJET CHANGE BY CHANGE OR�ERS ........................................................ $7�,1C�S.�32
<br />3. C�NTRACT 5UA+17c] DATE �l_i�lc 1:: 2] ............................................................ �G,3C,�,�k�4.42
<br />4. TOTAL GOMPLETED 8 STaREa TO aAiE {Cc3lurnn (; or� C;7f}3) ..............,.. !sb,337,3h�,72
<br />5. RETAiNAGE:
<br />a. �.{}f1 ° n o1� C:t�m��lct4d 4i�c�rk
<br />(C'�31umn I) — E t,n G7�1.;] S�J,217.73
<br />i), f] °I� nf 4(nre� h�3aleri�}i
<br />(Caluanir F on G7G3}
<br />�I'c�t�il FLetaitia�;e (l�ir3es �.i ! SI, t}r Tc�t.il in L'c�liimn I of'G7f13� .................
<br />5U.0[]
<br />�49,217,73
<br />6. 7f]TAL EARNEC} LESS 3�ETAlI�AGE ................................................................... SG,2�8,1 Gfi.99
<br />(Line 4 Lcss Lin� 5 'I'atal}
<br />7. LESS PREVIOUS CEf�'iIFICA7E5 F�R PAYMENT ...............�.,....,.,.......,....,...... 5G.274,125.�4
<br />(Linc f, f'rnnt prinrCcrti(icati:]
<br />8. CURRENT PAYMENT DUE .......................................................................... '1� 1�.�)�31.75
<br />9. BALANCE T(} F1NI5H, INCLUaING RETAINAGE
<br />{��I]1L` 3 �i:55 �,IS1C i3j
<br />�8�}.A 17.43
<br />C'1-3AfVCiI� ORDI;It SUMMA1tY Af)I71'I Itit'�15 i)I:I)LfC`f1[JNS
<br />icsl�rf chsmgcs apprav�d in prcvitws tnanths �y Ch�•n�r ;�7H.7fi�. �2 5l7.Uf1
<br />T��l€il ii�'I�7CU�'CCi IIiFS R�SCTI1lI5 ti[.}.�}[1 `��kf1[l.[}{r
<br />if]TlILS '�7:5.7(i�.��2 5=3(1Q.13{1
<br />NCT C'I-InNCsf:5 bv C'h;sEle� ()rcler :F7K, 5(i5.�2
<br />APPLICATIDH I�Q: ?�)-7c�(�-t] i ��
<br />P�RIf7[] Td: ��ily � s, 2[a22
<br />GONTRACT FfJR: Cicncrzdl CE�ttstruct�c�ii
<br />CaNTRACT dATE; L}ctaher ! 9, 2[12{�
<br />PROJECT I�QS; 12e�-74t] �
<br />Clistri�ution to:
<br />OWNER �
<br />ARCHITECT; �
<br />CDN�RACTOR� �
<br />FI�LD: ❑
<br />C7THER : �
<br />Th4 Ein�lcrsigi�cd C€�iltr�ictar cc��titi�y th�rl to th� best c�f tl�c C'or�Fract���''S 1<tt�wlcdgc,
<br />infbi•���ali��r� and Uc�icf' llsc Work [:n�crccl L�y tf�is Applicatioii fciz f'aymcnt h<iti bcei�
<br />cc�rnplctcd in �iccc�rd��ncc «Fith t��e Cn3itract �ocumcnis, ths�t all amo�tnts havc Uc�cn paid
<br />��y tl�e L'E�nt�'�Y�t:�� f[�r Wc�rlc foi• tuhicl� ]�ret+io��s C'ertilie;<<tes tc3z P��yr��ei7i were issueel s�n�l
<br />F�ayz��criiti rcccivai fi�an3 tli� O�er�, ancI fhak ctin�cn4 ��a_Yi��cr�t :slica��E� i�erciil is now cl�ic,
<br />C(]NTRACTQR:
<br />�i1': q/'✓ _ D�il�: �� ����1 � 7L
<br />5t.aie o4�: Mi»�t�sc� i
<br />C'aiinty c�f: f-lenn���in
<br />5iih,�9 ihcd ��nci sl��orr� tn bcfc�re RYAN S��7T S'1'RICKER
<br />n�u this � t'" �. d3}� ��C���� �,�y�Z .'. P~ �ryyCarnmiselon�res �a
<br />_ � y'�,� ,Ittnuarry 87, �Q¢8
<br />Notajry Ptil�li�: Ityan Slrickcr
<br />M.v C'ot�irziissinn cxptz�cs: Jan `_ 31, 2[k?fi
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />ln accortiaitcc ti�ilh lhe Cc}ntracF Ut�ct�rt�cntti, �asccl rr�t nr�-�itc nhscr�;itinr�s and the datl
<br />ec3m��risin�; tfii� a�a��lic�tic�ii, tllc r'1z�chilcGi ccrtifi�s tc� tl�o (]wncr tl���l to thc 17cst c�i' tl�c
<br />Arcl�itecl's k��c����lcd�e, infc�r����tion and bel�el` the Wc���k I�as �r��gi�essed as ii�dicatetl, tl�e
<br />quality caf'the 4�Vork is in accc�rc�tince ��•ith the C"ontract Docui�7:ents, zinc! the (:017fI'�iCT4f IS
<br />ctttiticti lo ��a,ymct�t crf thc ANtOUNT CT�TfrII:D.
<br />AMOLINT CERTIFIE[] ...................................................................................... `� I �i.�1d i .75
<br />[rlllrrclt �°:���lrzrrrrlirrir if�rr�xar�t+! r�c•�•tifiE�t! rlt//i°�s' ji'r�n� 1hc rrifiarnriat rrpplrcrl. lr+irrral rrll ji,�urr•.r u1i tllis
<br />.1pf�liculiurl citt{f rt�t ll�.� [:uir�iirrx rrnrr �Yrc�el flia! �trc [_'/!lrFt�;['t�lti t°r�3r�o1°�i1 tvtdil ll�e� rrn�nrrtrf eerdi�ied.l
<br />ARCHITECT:
<br />t���: ' v.��� 08/04/2022
<br />'1'Itiiti t'erliffcate iti nc,t i�egniiahle. Tltie AMUiJN`I° CNRi'I}�Il:I] it ��;ay��hl� u��ly tu t}tc Cuistr.icti�r
<br />namcd he�cin. Issr���n�c. �Sa�'mcr�t a�ut acccpteislce o!' ����y�ncnt sirc u�illraut ��i�judic�: iu any ri}�hts of
<br />tklc C)«�i��r nr C'cml�;ictnr unelce this C'nntract.
<br />AIA Document G7�2" —1992. Copyright [7 1953, 1963, i965, 7971, 1978, 1983 and 1992 By The Amerir.an InsiituYe of Arch�tecls. RI3 righis eesen+ed. Ths "Ameri�an Institute of Ar�hltects," "AIA," the AIA �oga,
<br />"G7D2," �nd "Ak�l Conlracl �7acumenrs" are regisfered lraeiemarks and may nnt be used without permisslvn. This documerat was producad by AIA sofhvare at 13:26:39 CT on OS1f7312022 under Drder No.2114310719
<br />which expires on 04l24F2p23, is no4 !De resale. is licensed for one-time use only, and may only be used in aCcardanc� with Ihe A1A Gonlracl bocuments�' Terms oF Service. To repa�! copyright viofations, e-mai!
<br />capyright@aia.arg.
<br />User Notes: �gggq�pg�y
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