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<br />����1� �
<br />am�=- Document G702 —1992
<br />_�
<br />Application and Certificafe for Payment
<br />TO OWNER: City of �Ik River PROJECT: 20-70� �lk River Fire Station #3 APPLICATION N0: 20-705-020 Distribution to:
<br />13065 Orono Parkway NW PERIOD T0: August 31, 2022 OWNER: �
<br />Ellc River, MN 55330
<br />CONTRACT FOR: Gencral Construction ARCHITECT: �
<br />FROM Tcrra Gcncral Contractars VIA BKV Group CONTRACT DATE: Octobcr 19, 2020
<br />CONTRACTOR: 2�025 Commerce Blvd Ste 1Q00 ARCHITECT: 22? N 2nd St, #101 PROJECT NOS: / 20-705 !
<br />Rogcrs MN 55374 MInneapolis, MN 55401
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />npplication is made for payment, as shown below, in connection with the Contract.
<br />AIA Document G703�, Contii�uation Sheet, is attached.
<br />1. ORIGINAL CONTRACT SUM ................................................................................ �6,898,246.00
<br />2. NET CHANGE BY CHANGE ORDERS ................................................................. �f,253.90
<br />3. CONTRACT SUM TO DATE (Linc 1� 2) ............................................................ $6,904,499.90
<br />4. TOTAL COMPLETED � STORED TO DATE (Cohimn G on G703) ................. $6,869,088.52
<br />5. RETAINAGE:
<br />a� 5.00 % of Complcted Wark
<br />(Column D + E on G703)
<br />b• 0 % of Stored Materia]
<br />(Column F on G�03)
<br />�91,SR4.87
<br />$0.00
<br />Total Retainage (Lines 5a + Sb or Total in Cohimn I of G703) ................. $9] ,584.87
<br />6. TOTAL EARNED LESS RETAINAGE ................................................................... $6,777,�03.65
<br />(Linc 4 Lcss Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............................................ �6,747,391.13
<br />(Linc 6 fi-om prior Certificate)
<br />8. CURRENT PAYMENT DUE .......................................................................... $30,112.52
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />$126,996.25
<br />CHANUE ORDER SUMMARY ADDITIONS DEDUCTiONS
<br />Total changcs approvcd in previous montlis by Owner $6,253.90 $0.00
<br />Total approvcd this Month $0.00 $0.00
<br />TOTALS $6,253.90 $0.00
<br />NGT CHANC�S b Chan e Order $6,25390
<br />CONTRACTOR: �
<br />FIELD: ❑
<br />OTHER: ❑
<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 receive o he Owncr, and that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By: Date: O �z
<br />State of: Min ota
<br />County of: Hennepin
<br />Subscribed and sworn to before � '"" RYAN SCOTT STRICKER
<br />me tllis 6 J�^ day of �'� ` �,� ��%�- !� ;;.. ,��Y Public, State of Minnesota
<br />' ����' MY Commission Expires
<br />t - January 31, 2026
<br />Notary Public: Ryan Siricker
<br />My Commission expires: Jan 31, 2026
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />In accordance witll 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 AMOUNT CERTIPIED.
<br />AMOUNTCERTIFIED ...................................................................................... $30,112.52
<br />(Attacl2 explanation if�amoaint certifiecl differs from the amount applied. Initial all fto �res on tlzis
<br />Application and on the ContinuaCio Sheet that are changed to confoYm with the amount certifted.)
<br />ARCHITECT:
<br />By: vate: 09/09/2022
<br />This Certificate is not negoliaUle. The AMOUNT CERTIFIED is payaUle only to the Contractor
<br />named herein. Issuance, payment and acceptance of payment are without prejudice to any rigrts 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 Institute of Architects," "AIA," the AIA Logo,
<br />`5702," and "AIA Contract Documents" are registered trademarks and may not be used without permission. This document was produced by AIA software at 14:54:10 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: (3B9ADA4E)
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