3.2. SR 11-19-2007 - Laserfiche WebLink

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APPLICATION AND CERTIFICATION FOR PAYMENT ArA DOCUnrENTG~oz PAGE ONE OF PAGES TO OWNER: City of River 130 ~ Orono Parkway Elk Rivcr, MN 55330 FROM CONTRACTOR: RJM Construction, Inc. 5455 Highway 169 Plymouth, MN 55442 CONTRACT FOR: General Construction 380 St. Peter Street, #600 St. Paul, MN 55102 APPLICATION NO: One PERIOll TO: 9/30/2007 PROJECT NOS: 207197 CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM $ 10,926,201.00 2. Net change by Change Orders $ O.Op 3. CONTRACT SUM TO DATE (Line 1 f 2) $ 10,926,201.00 4. TOTAL COMPLETED & STORED TO $ 204,245.00 DATE (Column G on G703) 5. RETAINAGE: a. % of Completed Work $ 10,212 (Column D + E on G703) 6. % of Stored Material $ (Column F on G703) Total Retainage (Lines Sa + 56 or Total th Column I of G703) TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certiticate) CURRENT PAYMENT DUE BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 10,212.00 $ 194,033.00 $ 0 $ 10,732,168.00 CFIANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved ut revious momhs b Owner $G.OD Total a roved this Momh TOTALS $0.00 $0.00 NET CHANGES by Change Order $0.00 The undersigned Contractor certifies that to the best of the Contractor's ktowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor far Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. CONT TOR: RJM Constmction, Inc. Date: 10/5/2007 State of: Minnesota County of C Subscribed and s) ~gryLmlt~(o4~be~-foffjj a day Notary Public: ~)~ ~~~ My Commissio expues: /31/ OIO Distribution to: OWNER DARCHITECT CONTRACTOR 0 0 rnln,:~. ~:~ ~'"'d"'-' '!"v Commission Crl u s J...~. ~1-°'ll;. In accordance with the Contract Documents, based on on-site observations and the data comprising the application, the Architect certifies to the..Owner that ro the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the qualiTy of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ........... $ ~ ~ O J?j (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and oyl~te_ _ Cr' v 'nuatton Shee! brat are changed to confarni with the amount certified.) ARCHITECT: (J~(~/' By: ~ ~/ Date: /9 OGr ~, his C ficate is no negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G]o2 ~ APPLICATION AND CERTIFICATION FOR PAVMENr ~ ta92 EDITION ~ AIAO ~ ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1]35 NEW YORK AVE., N.W., WASHINGTDN, Oc 2Dn06-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. PROJECT: E1kI2iverYMCA VIA ARCHITECT: BWBRArchitects