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<br />APPV ATION AND CERTIFICATION FOR PAYMENT
<br />----,.,
<br />
<br />AlA DOCUMENT G702
<br />
<br />PAGE ONE OF
<br />
<br />PAGES
<br />
<br />PROJECT: Elk River YMCA APPLICATION NO: Six
<br />
<br />TOWNER:
<br />
<br />City of Elk River
<br />13065 Orono Parl<way
<br />Elk River, MN 55330
<br />FROM CONTRACTOR:
<br />
<br />RJM Construction, Ine.
<br />5455 Highway 169
<br />Plymouth, MN 55442
<br />CONTRACT FOR: General Construction
<br />
<br />PERIOD TO: 2/29/2008
<br />
<br />Distribution to:
<br />DOWNER
<br />DARCHITECT
<br />DCONTRACTOR
<br />D
<br />D
<br />
<br />VIA ARCHITECT: BWBR Architects
<br />380 St. Peter Street, #600
<br />St. Paul, MN 55102 PROJECT NOS: 207197
<br />
<br />CONTRACT DATE:
<br />
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Application is made for payment, as shown below, in cOIUlection with the Contract.
<br />Continuation Sheet, AIA Document G703, is attached.
<br />
<br />1. ORIGINAL CONTRACT SUM
<br />2. Net change by Change Orders
<br />3. CONTRACT SUM TO DATE (Line I '" 2)
<br />4. TOTAL COMPLETED & STORED TO
<br />DATE (Column G on 0703)
<br />5. RETAlNAGE:
<br />a. % of Completed Work $
<br />(Columo D + E 00 0703)
<br />b. % of Stored Material $
<br />(Column F on G703)
<br />Total Retainage (Lines 5a + 5b or
<br />
<br />Total in Column I of 0703)
<br />6. TOTAL EARNED LESS RETAlNAGE
<br />(Line 4 Less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR
<br />PAYMENT (Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE
<br />9. BALANCE TO FINISH, INCLUDING RETAlNAGE
<br />(Line 3 less Line 6)
<br />
<br />$
<br />$
<br />$
<br />$
<br />
<br />10,926,201.00
<br />0.00
<br />10,926,201.00
<br />4,424,175.00
<br />
<br />206,202
<br />
<br />$ 206,202.00
<br />$ 4,217,973.00
<br />
<br />$
<br />
<br />$ 3,381,419.00
<br />$ ,<;,;,;,:Il~(i;$S<t:olr,
<br />6,708,228.00
<br />
<br />CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
<br />Total changes approved
<br />in previous months bv Owner $0.00
<br />Total approved this Month
<br />TOTALS $0.00 $0.00
<br />NET CHANGES by Change Order $0.00
<br />
<br />The undersigned Contractor certifies that to the best of the Contractorts 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 by
<br />the Contractor for Work for which previous Certificates for Payment were issued and
<br />payments received from the Owner, and that current payment shown herein is now due.
<br />
<br />CO~R: RJM Construction, Inc.
<br />
<br />;rxLJ4 c;h~1 Date 2/29/2008
<br />
<br />State of: Mitmesota County of: Chisago
<br />Subscribed andJi&b~f, e n.1hi}2J
<br />Notary Public: fJ..~
<br />MyCommissio .Ires: /31/2010
<br />
<br />
<br />ARCHITECT'S CERTIFIC
<br />
<br />In accordance with the Contract Documents, based on on-site observations and the data
<br />comprising the 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,
<br />the quality of the Wark is in accordance with the Contract Documents, and the Contractor
<br />is entitled to payment of the AMOUNT CERTIFIED.
<br />
<br />AMOUNT CERTIFIED. . . . . . . . . . . $
<br />
<br />f(!J., sd.. -
<br />
<br />(Attach explanation if amount -certified differs from the amount applied. Initial all figures on this
<br />Application c1nd emthe Continuation Sheet that are changed to con/onn with the amount certified.)
<br />ARCHlTEC
<br />
<br />
<br />c.
<br />
<br />Date: 11- fU~~ 4/
<br />
<br />1 negotiable, The AMOUNT CERTIFIED is payable only to the
<br />Contra named herein. Issuance, payment and acceptance of payment are without
<br />prejudice to any rights of the Owner or Contractor under this Contract.
<br />
<br />AlA DOCUMENT G702 . APPLICATION AND CERTIFICATION FOR PAYMENT. 1992 EDITION. AIAJ1J . Cl1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW., WASHINGTON, DC 20006-5292
<br />Users may obtain validation 01 this document by requesting a completed AlA Document 0401 - Certification of Document's Authenticity from the Licensee.
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