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<br />Document G702TM -1992
<br />Application and Cer#~ficate for Payment
<br />TO OWNER: CltyutElkRiver PROJECT: Eltct:iverF°hlict.ibrary APPLICATION Not ,2 Distribution to:
<br />PERIOD TO OWNER ^
<br />,znno7
<br />CONTRACT FOR: ,zr3vo7 ARCHITECT ^
<br />FROM CONTRACTOR: Mertiroa°censwcffonco.,ln°. VIA ARCHITECT: KKEArchltects CONTRACT DATE: CONTRACTOR ^
<br />18551 Buchanan Skeet NE 300 First Ave. North
<br />East Bethel, Minnesota 55011 Minneapolis, MN 55401 PROJECT NUS: 00,96 ~_
<br />r` FIELD ^
<br />OTHER ^
<br />CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information
<br />Application is made for payment, as shown below, in connection with the Contract. and belief the Work covered by this Application for Payment has been completed in accordance
<br />Continuation Sheet, AIA Document G703, is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for
<br />which previous Certificates for Payment were issued and payments received from the Owner, and
<br />1.ORIGINAL CONTRACT SUM ................................................. $ that current payment shown herein is now due.
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<br />2. Net change by Change Orders ....................:................:.... $ CONTRACTOR: Merrimac Construction Co., Ina ~~
<br />3. CONTRACT SUM TO DATE (Line -1 ± 2} .......... . .......................... $ ta.,s4.ool By: i Date:
<br />4. TOTAL COMPLETED & STQRED'T0 DATE (Column G on G703) ...... $ ~ ~ State of: ,
<br />5. RETAINAGE: 3sa7aozo° County of: M'""~°`~ ~
<br />a. F % of Completed Work ~`,. Subscribed and snworn to before
<br />(Column D + E on G703) $ , szs~,' a ?i V Z„ e, J me this Z~ day of p~. ~,a,~~.~ ,t D ~ 7
<br />b. % of Stored Material /
<br />(Column F on G703) $ Notary Public~r~+~ ~b!~~~
<br />My Commission expires: , ~
<br />Total Retainage (Lines Sa + Sb or Total in Column I of G703)....
<br />6. TOTAL EARNED LESS RETAINAGE ...................................
<br />(Line 4 Less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT .....................
<br />(Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE ..................................
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />$ 21 ~ t/3'2.
<br />8,692.69
<br />$ 373 ~ 0'1 ''~-
<br />3,675,017.50
<br />$ 21 ~ .lo3L, ~
<br />CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
<br />Total changes approved in previous months by Owner $ $
<br />Total approved this Month $ ~ $
<br />TOTALS $ s,oss.ao $
<br />NET CHANGES b Chan e Order $ la,,aa.oo)
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<br />NOTARY pUe~~ Ml ~C,E
<br />MYO~ ~~?orpTA
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT """"''~
<br />In accordance with the Contract Documents, based on on-site observations and the data comprising
<br />this application, the Architect certifies to the Owner that to the best of the Architect's knowledge,
<br />information and belief the Work has progressed as indicated, the quality of the Work is in
<br />accordance with the Contract Documents, and the Contractor is entitled to payment of the
<br />AMOUNT CERTIFIED.
<br />AMOUNT CERTIFIED .............................................................................. $ ..~1V ~ ~ l~J
<br />(Attach explanation if amount certified differs from the amount applied. initial all figures on this
<br />Application and on the Continuation Sheet that are changed to conform with the amount certified:)
<br />ARCHI ~!°~~
<br />By. 1~... Date: b
<br />This Ce icat i of negotiable. The AMOUNT CERTIFIED is payable onl to the Contractor
<br />named re' ssuance, payment and acceptance of payment are without prejudice to any rights of
<br />the Owner or Contractor under this Contract
<br />CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not he obscured.
<br />AIA Document G702TM -1992. Copyright ©1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA'" Document is protected by U.S. Copyright Law
<br />and International Treaties. Unauthorized reproduction or distribution of this AIA' Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
<br />passible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, a-mail The American Institute of Architects' legal
<br />counsel, copyright@aia.org.
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