3.3. SR 05-19-2008 - Laserfiche WebLink

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'~PP~;C~ATION AND CERTIFICATION FOR PAYMENT AiADOCVn~rENTC~oa PAGE ONE OF PAGES 'O OWNER: :ity of Elk River 3065 Orono Parkway ;Ik River, MN 55330 'ROM CONTRACTOR: t3M Construction, Inc. PROJECT: ElkRiverYMCA VIA ARCHITECT: BWBRArchitects 380 St. Peter Street, #600 APPLICATION NO: Eight PERIOD TO: 4/30!2008 455 Highway 169 St. Paul, MN 55102 PROJECT NOS: 207197 `~ O ~~ 'lymouth, MN 55442 ;ONTRACT FOR: General Construction CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractot'skmwledge, Lpplication 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 ;ontinuation 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. ORIGINAL CONTRACT SUM $ 10,926201.00 Net change by Change Orders $ 0.00 CONTRACT SUM TO DATE (Line 1 t 2) $ 10,926,201.00 TOTAL COMPLETED & STORED TO $ 6,890,880.00 DATE (Column G on G703) RETAINAGE: a. % of Completed Work $ 326, 126 (Column D + E on G703) b. % of Stored Material $ (Column F on G703) Total Retainage (Lines Sa + 56 or Total m Column I of G703) TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) LESS PREVIOUS CERTTFICATES FOR PAYMENT (Line 6 from prior Certificate) CURRENT PAYMENT DUE BALANCE TO FINISH, INCLUDING RETAINAGE (Line 31ess Line 6) $ 326,126.00 $ 6,564,754.00 $ 5 551,962.00 $ 4,361,447.00 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 6 Change Order $0.00 CONTRALTO ~ RJM Construction, Inc. ' By: ate: OS/01!2008 State of Minnesota CGUnt}~of~C t,~cafo _ __~.~-._~. Subscribed and sw to before m N' st ~` ,Qa~ ufMay 2oo~ARA L HOLT Notary Public: //yq~m~~~(~, /7J V ~ * ~:~. My Commission exp" rres: IY31/ 10 y -- NOTARY PUBLIC ~ MINNESOTA nrwnr r c~, r J VCR 1 Irll,n 1 C rvR rri r rvtcr~ 2 -~ - In accordance with the Contract Documents, based on on-site observations and the data comprising the application, the Architect certifies to the Owner Nat to the best of the Architect's knowledge, information and belief the WGrk has progressed as indicated, the quality of the WGrk is in accordance with Ne Contract Documents, and Ne Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ........... $ / 0 1 Z` (Attach explanation if amount cert~ed differs from the amount applied, Initla7 a71 figures on this Application and onthe Continuation Sheet that are changed to conform with the amount certified) ARCHITECT' ~ rrf~i'^rSC ~nf7. By: Date: ~ 2>Q9t~ This Certi cafe is not negotiable. The AMOUNT CERTIFIED is payable only to e Contractor named herein. Issuance, paymem and acceptance of payment aze without prejudice to any rights of the Owner or Contractor under this Contract. Distribution to: .W DOCUMENT G-02 ~ APPLICATION AND CERTIFICATION FOR PAYMENT` 1992 EGITKIN ~ AI4®~ ®1992 THE AMERICAN INSTITUTE of ARCHITECTa, 1]35 NEW YORK AVE., N.W., WASHINGTON, OG 200065282 Jsers may obtain valida0on of this document by requesting a completed AIA Document 0407 - Certiflcaflon of Document's Authenticity from the Licensee.