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APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES TO O~CNER: City of Elk River 13065 Orono Parkway Ellc River, MN 55330 FROM CONTRACTOR: RJM Construction, Inc. PROJECT: Elk River YMCA VIA ARCHITECT: BWBR Architects 380 St. Peter Street, #600 APPLICATION NO: Two PERIOD TO: 10/31/2007 Distribution to: OWNER ARCHITECT CONTRACTOR 0 5455 Highway 169 St. Paul, MN 55102 PROJECT NOS: 207197 Plymouth, MN 55442 CONTRACT FOR: General Construction CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line 1 f 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. % of Completed Work (Column D + E on G703) b. % of Stored Material (Column F on G703) Total Retainage (Lines Sa + Sb or $ 10,926,201.00 $ 0.00 $ 10,926,201.00 $ 645,973.00 $ 32,299 Total in Column I of G703) TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) CURRENT PAYMENT DUE BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 32,299.00 $ 613,674.00 $ 194,033.00 $ 10,312,527.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in revious months b Owner $0.00 Total a roved this Month TOTALS $0.00 $0.00 NET CHANGES b Change Order $0.00 CONTRACT RJM Construction, Inc. i By: i~ ~ Date: 11/8/2007 State of: Minnesota County of: Chisago ~ Y v ~ t+# 4 ~ L 1=j.(,) L I Subscribed and sw to befor me is 8 _ , day of November 00 %~~r ; N O I A N Y P U B L I C Notary Public: ~~'J~y12i ~ ~~~ ,~{~ MINNESOTA My Commission xptres: l 1/2010 ~ ,,, My Commission Expires Jan.31, 201Q , ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising the application, the Architect certifies to the Owner that to 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 ........... $ ~/ (Attach explanation if amount certtfied dyers from the amount applied. Initial all frgures on this Application and onthe Continuation Sheet that are changed to conform with the amount cert f ed.) ARCHITE T: ;~ R rchitects, ~C1C. nyy By. Date: 2ls ~/~ (/ ~ir~/'~ is Ce t ica a of negotiable. The AMOUNT CERTIFIED is payable only to the Contr or named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 ~ APPLICATION AND CERTIFICATION FOR PAYMENT ~ 1992 EDRION ~ AIA®~ ®1992 THE AMERICAN INSTRUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of th(s document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee.