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<br />~:~=AlA Document G702T" - X992
<br />Application and Certificate for Payment
<br />TO OWNER: cmmFlxaw.r PROJECT: Flranarr.clwus,.y APPLICATION NO: ,a Distdbutfonto:
<br /> PERIOD T0: 9tnsroe OWNER ^
<br /> CONTRACT FOR: 01F"ro6 ARCHITECT ^
<br />Mertimw CmeN 1bn G., Inc. KKE Mdtllww
<br />FROM CONTRACTOR:
<br />VIA ARCHITECT:
<br />,sptawn.nwsmxuF
<br />so9Rme~...unm, CONTRACT DATE: CONTRACTOR ^
<br />Fact aBihN, Mnmwb 55011 Mnnaepollc. xlrl 55Cm 9691%
<br /> PROJECT NOS: / /
<br /> FIELD ^
<br /> OTHER ^
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Application is made for payment, as shown below, in connection with the Contract.
<br />Continuation Sheet, AIA Document G703, is attached.
<br />1.ORIGINAL CONTRACT SUM ......
<br />2. Net change by Change Orders ..........................................
<br />3. CONTRACT SUM TO DATE (Line t t 2) ........................... _........
<br />4. TOTAL COMPLETED 8 STORED TODATE (Column G on G703) ......
<br />5. RETAINAGE:
<br />a, o % of Completed Work
<br />(Column D + E on G703)
<br />b. _% of Stored Material
<br />(Column F on G703)
<br />$ 3,%1,091.%
<br />$ 9.91900).09
<br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, inforration
<br />and belief [he Work covered by this Application far Payment has been completed in accordance
<br />with the Contract Documents, that all amounts have been paid by [he Contractor For Work for
<br />which previous Certificates for Payment were issued and payments received From the Owner, and
<br />that current payment shown herein is ow e.
<br />CONTRACTQ~ c>, Im
<br />__
<br />By: Date: o,nsno%
<br />State of: ~-
<br />X09--- ulnn.eo,.
<br />County of:
<br />$ ° 7S I~d >~
<br />Awke
<br />Subscribed and sworn to before
<br />me this Z 7 day of ,Jar r,a..7 ,Z p, f
<br />0p Notary Public:~dJ
<br />Total Retainage (Lines Sa + 56 or Total in Column I of G703).......
<br />6. TGTAL EARNED LESS RETAINAGE ....................................
<br />(Line 4 Less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT .............
<br />(Line 6 from prior Certificate)
<br />~ M C
<br />is„+ ,,, ... .. . .._. ....,. ,
<br />~'° x JOHN M. MILLcH ~
<br />NDiAgy pOgL1C,MINNESOTq
<br />N grCmmirap,Egiry,lr491. 1010
<br />
<br />$ 'L ~~. y onumsston expires. ~
<br />$3f$74 7',00
<br />
<br />8. CURRENT PAYMENT DUE ............................................. [6~~~
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE 00
<br />(Line 3 less Line b) $ ~ 75, Oda ~
<br />CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
<br />Total changes approved in previous months by Owner $ a $
<br />Total apptnved this Month $ $
<br />TOTALS $ $
<br />NET CHANGES b Chan a Order $ 1s.wa.ool
<br />I/3r/i,
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />In accordance with the Con[rac[ Documents, bused 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, [he quality of the Work is in
<br />accordance with [he Contract Documents, and the Convector is entitled [o payment of the
<br />AMOUNT CERTIFIED. SS
<br />AMOUNT CERTIFIED .............................................................................. $ 8 I Z .
<br />(Anach explanation if amount certified differs from the amount applied. Initial all fi ures on this
<br />Application and an the Continuation Sheet shat are changed to con(nrm with the amount eerti,Ted.)
<br />ARCHIT /~/~ ,/
<br />By: ~ ~L/~7y y/~ Date: i~
<br />This Certificate is not ne~go~tiable. The AMOUNT CERTIFIED is payable only to the Contractor
<br />named herein. Issuance, payment and acceptance of payment aze without q'ejudice [o any rights of
<br />the Owner or Contractor under this Contract
<br />CAUTION: You should sign an original AIA Contract Document, on which ibis text appears in RED. An original assures [bat changes will not be obscured.
<br />AIA Document D702m -1992. Copyright ®1953, 1983, 1965, 1971, 1978, 1983 an_d 1992 by The American Institute of Architects. All Nghta reserved. WARNING: This AIA°° Document is protected by U.S. Copyright Law
<br />antl International Treaties. Unauthorized reproduction or distribution of This AIA` Document, nr any portion of it, may resul7 in severe civil and criminal penalties. and will he prosecuted 10 the maximum extent
<br />t9ossible under the law. Purchasers are permitted to reproduce ten (10) espies of this document when completed. To repoa copyright violations of AIA Contract Documents, a-mail The American Insthute of Architects' legal
<br />counsel, copyright@aia.org.
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