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<br />►4p�r�icafr'on arrd� Cer#rf�cafe for Paymenf
<br />TQ (]WNER
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<br />� 1iL' Sl� �I�< ��lf'C3
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<br />Rngcrti M1V 55374
<br />PRQJECT
<br />V�A
<br />ARGHITECT:
<br />'�}-71}i fiEk Iti��cr 1=irc 5la�inn t13
<br />[3 K V C7rc>�iE�
<br />?2? i�i 2n�1 St. �I I f11
<br />Mltin�����alis, Iv3h� �5�{IF
<br />CaNTRACT�R'S APPLICATf�N F�R PAYMENT
<br />�1����licatio3� is rnad� lc�r ��aymCnt, P15 SIlf�14'll I]C�O14', iIl (;()pllCCti(317 14'ith ihc Cc�nlract.
<br />AIA I)c�cuEnci7l C;`7[73". C'cmti�7�ia�inn 5hccl, is attr�cllecf.
<br />�. o�i�ir�,4�. �or�7�,eT sun� ................................................................................ ���.����,z�ar,.t�n
<br />2. NET CHANGE BY CNANGE �RDERS ................................................................. 5(�.2�,3.t)p
<br />3. CDNTRAC7 SUM 7C1 DA7E {L;nc i-t 2) ............................................................ ;s'Ci,9[y4,��)9,�)[)
<br />4. �t7iAL C�MPLET�D & STORED Ta F]ATE [Cr�ltE���n G c�n G7�}3j ................. SG,�37,391.13
<br />5. R�TA�NAGE:
<br />a. S,f1f1 "I„ c�t �'ontpfcTcc! Wnrk
<br />(C�OILittl]] � C i]i] G7��.�} $3�}l.${3t).Sfa
<br />k3. �Y ';�n ni 5tnrccl A/Ialeri�tl
<br />{LfYjLiETZ11 }' clra Gi{)3] �O.Of]
<br />Tt�tal I�ctainF�t;i {Liizcs Sa f 5i� or Ti�t;si in Cn1la�nsi l cYf'G7�1:3} ................. ;�3Al,tfi9.�f�
<br />fi. TQTAL EAR�lEO LESS RETRINAGE ........� .......................................................... 5f�,�}95.j21.a7
<br />{Linc 4 L.�ss Line 5 Talal)
<br />7, LESS PREVIO�fS CERTIFIGRTES FOR PAYMENT ............. .............................. 5Cj,48�,3{)i.? 1
<br />{�itie ti linrti prit�rCcrlifii:tE�)
<br />8. CURRE�1T PAYMENT DUE .......................................................................... �9,1 t(}.3[�
<br />9. BALAfVCE TO FINiSH, INCLUI3ING RE7AINAGE
<br />{i_inc 3 fs�sti I_i»i ti}
<br />$�0'i.97�.:i3
<br />C'i-ir1hIC�1: [)I�Ul:R SUh4MARY Af7f)IZ'It)N5 I71?I)Ll�'�'R[)1�S
<br />Ttat.�i cfta�igCs a�z7�ro��cd in prc��ic3t�s mc>>ith� l}y {]wncr ti$14.[i9 �{7.[}(1
<br />Tnt,tif apj�et�vc:c! lhis h�lar�if� �i,�13�),'? 1 SfJ,[]U
<br />T�)TALS SG,?5�.9{3 �;{7.(3{1
<br />�fGT CFIt1NCiC5 t�v C`haii�e f7rder Sf,25�.9I]
<br />APPtICATION N4. 2t�-�c�5-�� i r,
<br />P�Rf�� TU: r«��� ��, ��22
<br />GCIHTRACT F[3R: (�ct�ca;il l:nnstri�ctinn
<br />Cf}NTRACT �ATE: Cl�tober 19, 2[]2�]
<br />PR�JECT N4S: i �p-70� '
<br />Distributian to:
<br />OWNER: �
<br />ARCHITECi� �
<br />CQNTRACTaR; �
<br />FVELED: �
<br />ClT�1ER : ❑
<br />�1'17� ui�dersi�i3��1 Gc�ntractc�r c�rtiticti tl7at tu tlie Ucsf trl� lltc C:c�Tltractor's kn[r���eeige,
<br />ir�fi�r�natior� a�id hclici' the W��zk c«v�rcci l�y this Applicztic�i7 ic�r Pay�ncnt h�i5 bccn
<br />cnm��lctctl izi �ccna•d��ncc with thc C«nt���ct Docuincnts, tlril a�ll an�nitr�ts f�avc Uc�ii p�id
<br />��y tEie L'ai;ir•actc�r lcsr W«rk fi�r ivl�icli previous [.'�rtiiicates tl'or E'ayment W�ere issu�ci ai�d
<br />�ayi�lcnt� rtCs:i��Cd 1�rc>m t C)w cr, srontl that cti�rrcnt �I1j+131Cf1t S�l{��+Il IlL'I'C117 lS itOW CIL1C.
<br />CdN7RAC7DR:
<br />r�j�: ��c�: �,3 ��Z
<br />Stale of: Mir�neso�a
<br />Coutity oF: Henncp' �
<br />5uhscrihed a�ad st�rs7i•n tn i�cl'nrc •%14 RY�41�1 SC�TT STRICIfER
<br />�»e �liis ;� t`� ti3y nF�� v`J� ��� � �r(`���irmi��lon�r ��
<br />� � . Jxnuary3l, 2028
<br />Nnlary P�7hli�: Ryan 5lrickcr ,
<br />11y Lnmm�ti5it7n cx�aires: .ianyi� 31. 2Q2(,
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />ln ��ccnrclEt��cc �� i[I� ti7�: Cnitir��ct L]e�c�amcnts, h�i'i[',(I C11} Cli1—tiILC Qt7SCI'V:1t1(]1lti unci ihc clat�r
<br />crn����ri�in� i�7is zip��licllac>n. thc Arcliit�ct ccrtilic4 tn Flic Dwncr t1�at �o t��e bcst €�f llic
<br />,hrc}7ilect's kitinwled�e, 111Ff}1'II7�1L1(711 �lilC� I7��I�t LIl� Wi)CIt IliiS �"31'C��1'ESSL'iI �S 1I1ff�IC[tlC'C�, the
<br />C�ll�l�1ly [)� T}l� �'9,Crl`�{ IS lfl iil'C(71°teill7(:t' �4'll3l t�14' t'L1111t'i1Cl TJ[ACtIIZ1211tS, �llill LIl� C�[JI1lPS['iUl' 1S
<br />rntitl�cl t€� �ai}��ncz7t nf thc AiVI[]U1�T CT�.RT1Fi�U.
<br />AM4UN7GERTIFIED ...................................................................................... �9, i ;D,3£;
<br />(;1 flr+ch <:r��lctttrrlin�t i� rr�rrnrrrrf cc°r�i}ir�ri rl��/i�r•.s fi•n�ir flrcr a�rrnrri�f rrfr�rlrc•rl. f��ftrrr! ulI Jt�;r.r�-es r��� 11ris
<br />:lfr��iacrrfrnia nlrri rr�r /fro-° CFntttir�rrcrPrn �,ihc�rr Il+ut u�•e chari�trl lri �'utr�c�rrf7 rvrli� 11rc rrr�tairi3! � erlr�ic•c1,1
<br />ARCHIT�CT:
<br />[���= r���s�: 08/04/2022
<br />ThiG C'erlificsile is s7ol tiegoliai�i�, Tl�� ��,ivIUU1YT C'I:i{'I'Il�ll:i7 iti �ray.thl� nnlv la flte C'�}nlrar:�c}r
<br />,7��med h4r�.is�. ltisuar�c�. �riytticr�t aiid �icci:��t�incc c�f payizlent �sic w,�itt���it �arcjt�dicc t� xny ri�:l�ts of
<br />thc C)G��ner �r C:nnlrsoc�nr �3ntler this Cc�zitract.
<br />A1A Document G702'%-1992. Capyright Cw 1953, 1963, 7955, 1971, 7978, 1983 and 1992 6y The Rmerir,an Ins[itute of Architects. AIE riyhts reserveB, The `American Insti[u[e of Rrchilects," "AIA," the AIA Lngn,
<br />"G7p2," �nci "AIA Conlrac� [7ncumenrs" are registered lra�iemarks and may not be used without permisslon. This documenl was produ�eci hy AIA sofiware at ifi:27:Op GT an Q8103J�022 uncler Order h1o.211437{1719
<br />which explres on 0412412423, is nal for resale, is Ilcensed far ai�e-lime use nnly, and may anly he used in accordance with lFre /IfA Cnntract �Qcuments•`° ierms of Serv'rce. To report copyric�hE �iala�ions, e-ma�il
<br />cQpyeight�aia.arc�.
<br />User Notes: {3B�3AC}A49j
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