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<br />AI'" IH) <br />1111 ^~ <br /> <br />In ,l( {"()r(J~}nce \vi tll the Coni rJcl Documcnt~, based on on-site observations and the <br /><L,ta cornprising Ihe above appljealion, Ihe Architect certifies 10 the Owner (hat(o the <br />h('~1 of the Architect's kncJ\vledge, ;n(ormJlion and belief Ihe Work has progressed .1S <br />indi( .lh'd. .ht' qUJlily of Ihe \Vofk is in accordance wilh the Contr.lc,1 Ou(unll'nl~, .lnd <br />thl' C"ootr\lctor h entirled 10 pJ}'mcnt (J( the AlvtOUNT C[f{Tlfl(f). <br /> <br />(NT G701 . AI' <br />AN IN'. 1I111 II <br /> <br />ICA11 <br />)f ^~ <br /> <br />)N AND CUU <br />I till Cl\. 17 <br /> <br />Fie All r OJ( Pt\Yt-.U NT <br />'i Nt \V YOHK AVlNlJl <br /> <br />""AY IfIU t t DillON · AI^' <br />N .\\1,. \VASHIN(, ION, D, C. <br /> <br />JIll <br />1(}(Klh <br /> <br />lJy: ).uc Z <br />'--" . <br />This Ccr I ificat e is not ncgoli.lhlc. The ^,\.\()UN T C~ f{ r I f I L [) h 1~.lr,lh Ie <br />Con I r .ll tor nJmcd herei n. I ssuan('e, p.lynlt'fl t and a(TPpt.lnc:c 01 p.lY'llL'n t <br />prcjudic'c to any rights 01 the O\vncr or Conlr,lcror under I his C' " rJct <br /> <br />AMOUNT CERTifiED <br />(Atlach c.'xp1.1 f)JI ion if <br />AKCt.J tl{ CT <br /> <br />{{;l{7f) rZ(Jl1/'-- <br /> <br /> <br />(;70'l. <br /> <br />o Ill)' . () III L' <br />..lrt! \\'ilholll <br /> <br />~ 1 <br /><1) <br /> <br />fur, ) <br />I <br /> <br />fl'l <br /> <br />If( <br /> <br />ilL' <br /> <br />$ 1_, L}~ <br />.1/1lOUfl( .1ppllt.'cJ <br /> <br />an)()(J( <br /> <br />cert i liec/ <br /> <br />dll(l'r~ <br /> <br /> <br />\y <br /> <br />Dill e <br />anager <br />CATE FOR PAYMENT <br /> <br />6 <br /> <br />/0 <br /> <br />/93 <br /> <br />c" <br /> <br />Slale ot:~ Minne~. ta C' Counr~t;~\ iN. EVENS <br />Subscrib 'f.l!rAJn 0 SC/1rJ) C 'lC (Mili . 1 ~~~~ Vf Pij~~~pMfNNESp9P. <br />NOI ar P ~ . . " . OAt<OtJ.. CmJNTY , <br />Y b , My COmm. Expires July 22, 19~ <br />My COOl m i s s; () n c)( p ire s : 7 / 2 2 / 9 7 .. vvvvvvvvvvvVvvvvvvvvvv I y\/yVVv,,' <br /> <br />). <br /> <br />. <br />> <br /> <br /> <br />9~ <br /> <br /> <br /> <br /> <br />, <br /> <br /> <br />C()N <br /> <br />Chdn~ <br /> <br />I he ulldl'rsigned Contractor certifies th.lt to the best of the Contractor's knowledge, <br />nlorrn.lIion illld belief the \\'ark covered by Ihis Application {or P.1yrnent htlS been <br />(orllph'h.'d in ,lccordancc vvith the ContrJct Documents, that all arnounts have been <br />p.lid hy the COlllrJctor for Work for \vhich previous Certificates for P,lynlcnt were <br />i~~\tl'd and pay,ncnts received Ironl the Owner, and that current payment shown <br />I1l'rl'in i~ now due. <br /> <br />Nel (h~Jng(! by <br /> <br />lOTAlS <br />Orders <br /> <br />Lill <br />(jJ!l <br /> <br />307.00) <br />307.00) <br /> <br />7. <br /> <br />6. <br /> <br />T <br /> <br />~ACl OR <br /> <br />BOR-SON Construct <br /> <br />on <br /> <br />nc <br /> <br />8. <br />9. <br /> <br />or <br />or G70J) <br />TOTAL EAItNED LESS RETAINAGE <br />(I.ine 4 less l.ine 5 Total) <br />LESS pnEVJOUS CERTIFICATES fOR <br />PAYMENT Ctine b (rurn prior Cer <br />CUltUENT PAYMENT DUE. . . . . . . . . . <br />BALANCE TO FINtSI-t, PLUS RETAINAGE <br />ine 3 less line 6) <br /> <br />cat <br /> <br />c) <br /> <br />S <br />$ <br />$ <br /> <br />2 <br /> <br />013 <br />21 <br />33 <br /> <br />'I 3 It <br />0/-19 <br />709 <br /> <br />75 <br />5 <br />o <br /> <br />s __ 107. 078 . 1 0 ._ <br />S _f..LO 3 LII 118 3 . 9 0 <br /> <br />-7 <br /> <br />Approved <br />Nunlber <br /> <br />Cl-iANGE Of{OER SUt....tM,\RY <br /> <br />Chan~c Orders approved in <br />)rt'vi()u~ months by O\vner <br />TOTAL <br /> <br />h <br /> <br />Monlh <br />Dale Approved <br /> <br />($lLl, <br /> <br />307 <br /> <br />00) <br /> <br />DEDUCTIONS <br /> <br />5. <br /> <br />1. <br />2. <br />3. <br />4. <br /> <br />ORIGINAL CONTRACT SUM <br />Net change by Change Orders <br />CONTRACT SUM TO DATE (line :t 2 <br />TOTAL COMPLETED & STORED TO DATE <br />(Column G on G70J) <br />RETAINAGE: <br />a. -2.. % of Completed Work <br />(Colun1n D + E on G703) <br />b. _ % of Slored Malerial <br />(Column F on G70J) <br />Total RC1l\inage <br />Tolal in Col <br /> <br />line Sa + Sb <br />mn <br /> <br />s <br /> <br />$ <br /> <br />07 <br /> <br />078 <br /> <br />"0 <br /> <br />$ <br />S <br />S <br />S <br /> <br />2 <br /> <br />2 <br />2 <br /> <br />82 <br />fij <br />68 <br />41 <br /> <br />500 <br />307 <br />193 <br />562 <br /> <br />00 <br />00 <br />00 <br />00- <br /> <br />ADDITIONS <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br />Application is <br />Continuation <br /> <br />made for Payn1enl, as <br />ShccC, AlA Docunlcnl <br /> <br />shown belovv, in connection wi <br />G70J, is allached. <br /> <br />DhlflDUllon 10 <br />DOWNER <br />o ARCriJT[CT <br />o CONTRACTOR <br />o <br />o <br /> <br />C()NTRACT <br /> <br />CONTRACTOR): <br />BOR-SON Construction, <br />2001 Killebrew Drive, #1 <br />Bloonlington, MN 55425 <br /> <br />fO~ <br /> <br />Inc <br />41 <br /> <br />VIA (ARCl-UTECT): <br />EOS Architecture <br />21 Water Street <br />Excelsior, MN <br /> <br />5533 <br /> <br />CONTRACT DATE <br /> <br />ARC~ilT[CT'S <br />r~OJECT NO <br /> <br />c Con <br /> <br />rJ( <br /> <br />f. <br /> <br />{()f\\ <br /> <br />5/08/93 <br />6/01/93 <br /> <br />City of Elk River <br />720 Dodge Avenue <br />Elk River I MN <br /> <br />N.W <br />55330 <br /> <br />PERIOD TO <br /> <br />l() <br /> <br />APPLICATION AND CERTIFI <br /> <br />()\VN[ ~ <br /> <br />)~O <br /> <br />CATE FOR PAYMENT <br /> <br />fer <br /> <br />AlA DOCUMENT G702 <br />Elk River City Hall / <br />Police Station <br /> <br />APPl <br /> <br />1S <br /> <br />rue <br /> <br />CATION NO <br /> <br />nns <br /> <br />on <br /> <br />reverse Side <br /> <br />"ACI <br /> <br />()Nt <br /> <br />or <br /> <br />\ <br />