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<br />�'�== Document G702 -1992
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<br />Application and Certificate for Payment
<br />TO OWNER: City of �lk Rivcr PROJECT: 20-705 L,lk River Fire Station #3 APPLICATION N0: 20-705-021 Retainagc Distribution to:
<br />13065 Orono Parkway NW PERIOD T0: nu��st 31, 2022 OWNER: �
<br />Elk River, MN 55330
<br />CONTRACT FOR: General Construction ARCHITECT: �
<br />FROM Terra General Contractors �/�Q BKV Group
<br />CON7RACTOR: 21025 Commerce Blvd Ste 1000 ARCHITECT: 222 N 2nd St, #101
<br />IZogers MN 55374 Mlnneapolis, MN 55401
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />npplication is made for payment, as shown below, in connection with the Contract.
<br />AIA Doeument G703�', Continuation Shcct, is attached.
<br />1. ORIGINAL CONTRACT SUM ................................................................................ �6,898,246.00
<br />2. NET CHANGE BY CHANGE ORDERS ................................................................. �,6,253.90
<br />3. CONTRACT SUM TO DATE (Linc 1� 2) ............................................................ $6,904,499.90
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) ................. $G,869,088.52
<br />5. RETAINAGE:
<br />a. 5.00 % of Completed Work
<br />(Cohimn D + E on G703)
<br />b. 0 % of Stored Material
<br />(Column F on G703)
<br />�io,000.00
<br />$0.00
<br />Total Retainage (Lines Sa + Sb or Total in Column I of G703) ................. $10,000.00
<br />6. 70TAL EARNED LESS RETAINAGE ................................................................... $6,859,088.52
<br />(Line 4 Less Linc S Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................ $6,777,503.65
<br />(Linc 6 from prior Ccrtificatc)
<br />CURRENT PAYMENT DUE .......................................................................... �81,584.87
<br />BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Linc 3 Icss Linc 6) �45,4113�
<br />CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
<br />1�otal changes approved in previous months by Owner �6,253.90 $0.00
<br />Total approved this Month $0.00 $0.00
<br />TOTALS $6,253.90 $O.Oa
<br />NCT CHANG�S b Chan e Order $6,253.90
<br />CONTRACT DATE: October 19, 2020
<br />PROJECT NOS: / 20-705 /
<br />CONTRACTOR: �
<br />FIELD: ❑
<br />OTHER: ❑
<br />The undersigncd 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 bcen paid
<br />by the Contractor for W rk f r which previous Certificates for Payment were issued and
<br />payments received fr he wner, and that current payment shown herein is now duc.
<br />CONTRACTOR:
<br />By: Date: 22
<br />Slate of. Minnesot
<br />County of: Hen pin RYAN SCOTT STRICKER
<br />-�lry •eL
<br />Subscribed and sworn to before = - Notat�rPuWie,StateoiMinnesota
<br />me this �-�'i/� day of �.� � MY�+�P�
<br />!" / h � � Z� '' ::::� � .�►,��y s,. 2ozs
<br />Notary Public: Ryan Stnckcr
<br />My Commission expires: Janti4ary 3l, 2026
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />In accordance with the Contract Documents, based on on-site observations and thc data
<br />comprising this application, the Architect certifies to the Own�r that to tl�e best of the
<br />Architect's knowledge, information and belieF the Worlc has progressed as indicated, the
<br />quality of the Work is in accordance �vith the Contract Documents, and the Contractor is
<br />entitled to payment of the AMOUNT CERTIFIED.
<br />AMOUNT CERTIFIED ...................................................................................... �81,584.87
<br />(Attacl2 explanation if amount certi aed cliffers from the amount applzecl. Initial all figures on this
<br />Application and n the Continuati n heet at m•e changed to conform with tive amount certified.)
<br />ARCHITECT:
<br />By: Dat�: 09/09/2022
<br />This Certificate is not negotiable. The AMO[JNT CF,RTIFIED is payaUle only to the Contractor
<br />natned herein. Issuancc, payment and acceptance of payment are without prejudice to any rights of
<br />the Owner or Contractor under this Contract.
<br />AIA Document G702° — 1992. Copyright O 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. The "American Institu[e of Architects," "AIA," the AIA Logo,
<br />'�'702," and "AIA Contract Documents" are registered trademarks and may not be used without permission. This document was produced by AIA software at 14:59:02 CT on 09/08/2022 under Order No.2114310719
<br />which expires on 04/24/2023, 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: (369ADA54)
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