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APPLICATION AND CERTIFICATE FOR PAYMENT DOCUM£HT G702 <br />TO (OWNER): City of Elk River PROJECT: ADDITION TO ELK RIVER <br /> <br />(Instructions on reverse side) <br /> <br />APPLICATION NO: 1 <br /> <br />I'AG[ ON[ Of 2 I'A(;IS <br /> <br />Distribution lo: <br /> <br />13060 Orono P~rkw~y <br />Elk River, MN 55330 <br /> <br />FROM (CONTRACTOR): M. A. Mortenson Company VIA (ARCHITECT): <br /> 700 Meadow Lane North <br /> Minneapolis, MN 55422 <br />CONTRACT FOR: Addition to Elk River Ice Arena <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br /> CHANCE ORDER .S.UMMARy . <br /> Change Orders approved in ADDITIONS DEDUCTIONS <br /> previous months by Owner <br /> TOTAL <br /> Appro..ved this Month <br /> Number Date Approved <br /> TOTALS <br />Net change by Chanse Orders ' ' <br />"rE <br /> <br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, <br />information and belief the Work covered by this Application for Paymenl has been <br />completed in accordance with the Contract Documents, Ihat all amounts have been <br />paid by Ihe Contractor for Work for which previous Certificales for Paymenl were <br />issued and payments received from lhe Owner, and that current payment shown <br />herein is now due. <br /> <br />CONTRACTOR: M. A. .~.r~ny <br /> <br />In accordance with the Contract Documents, based on on-site observations and the <br />data comprising the above application, the Architect certifies to the Owner that to the <br />best of the Architect's knowledge, information and belief lhe Work has progressed as <br />indicated, the quality of the Work is in accordance with the Contract Documents, and <br />Ihe Contractor is entitled to payment of the AMOUNT CERTIFIED. <br /> <br />AIA DOCUMENT (;70'2 "APPtlCATION AND CERTIFICATE FOR PAYMENT · MAY 19~J [D~ <br />TIlE AMERICAN INSTITUIE Or ARCHITECTS, 173,5 NEW YORK AVENUE, N.W., WASH NGION, D.C. 20f~}6 <br /> <br />ICE ARENA <br />ELK RIVER, MINNESOTA <br /> <br />RSPArchitects <br />120 First Avenue North <br />Minneapolis, ~ 55401 <br /> <br />PERIOD TO: 7/1/96 <br /> <br />ARCHITECT'S <br />PROJECT NO: <br /> <br />CONTRACT DATE: 5/28/96 <br /> <br />OWNER <br />ARCHITI'CT <br />CONTRACIOR <br /> <br /> Application is made for Payment, as shown below, in connection wilh the Conlracl. <br /> Continualion Sheet, AIA Document G703, is attached. <br /> <br /> 1. ORIGINAL CONTRACT SUM ....................... $ 2,288,20.zJ.00 <br /> 2. Ne! change by Change Orders ..................... $ _ -O- <br /> 3. CONTRACT SUM TO DATE (Line 1 '~2) ....... ' ....... $ 2,288,204.00 <br /> 4. TOTAL COMPLETED & STORED TO DATE ............ $ .. 45,466.00 <br /> (Column G on G703) <br /> S. RETAINAGE: <br /> a..5 % of Completed Work $ 2,048.00 <br /> (Column D + E on G703) <br /> b. ~ % of Stored Material $ <br /> (Column F on G703) <br /> Total Retainage (Line 5a + Sb or <br /> Total in Column I of G703) ..................... $ 2,048.00 <br /> 6. TOTAL EARNED LESS RETAINAGE ................... $ 4_q;41R.Orl. <br /> (Line 4 less Line 5 Total) <br /> 7. LESS PREVIOUS CERTIFICATES FOR <br /> PAYMENT (Line 6 from prior Certificate) ......... $ _ 3r427.00 <br /> 8. CURRENT PAYMENT DUE .......................... $ 39,991.00 <br /> 9, BALANCE TO FINISH, PLUS RETAINAGE ............. $ _2,244,786.00 <br /> (Line 3 less Line 6) <br /> State of: ~TC~ County BAll <br /> Notary Public: L.~k~ ~ <br />~r~ 31, xY. O0~O "~. <br /> AMOUNT CERTIFIED ................................. $ <br /> (Attach explanation if amount certified differs from the amount applied for.) <br /> ARCHIT~: . _ , <br /> This Certificate is ng~eg'~tia~le. The AMOUNT <br /> Contractor namedJ~. ~'ein._.~. suance, payment and acceplance of payment are withoul <br /> prejudice to any r~.~f Ihe Owner or Contractor under this Contract <br /> <br /> <br />