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TO (O ,VNER): <br />CITY OF ELK RIVER <br />13065 ORONO PARKWAY <br />ELK RIVER, MN 55330 <br /> <br />FROM (CONTRACTOR): <br /> MORTENSON COMPANY <br />~.~. BOX 710 <br />MINNEAPOLIS, MN 55440 <br /> <br />PROJECT: MAM JOB NO: 951019 <br />ELK RIVER INVOICE NO: 17742 <br />ICE ARENA EXPANSION APPLICATION #: 3 <br /> <br />VIA (ARCHITECT): <br /> <br />ARCHITECTS PROJECT NO: <br /> <br />Distributionto: <br />__OWNER <br />__ARCHITECT <br />__CONTRACTOR <br /> <br />PERIOD FROM 07/01/96 <br />TO: 07/31/96 <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br />CHANGE ORDER SUMMARY <br /> <br />ADDITIONS DEDUCTIONS <br /> <br />Change Order's approved in <br />previous months by Owner <br /> <br />Approved this Month <br /> <br />Number Date Approved <br /> <br /> TOTALS 0 0 <br />Net change by Change Orders 0 <br /> <br />The undersigned Contractor certifies that to the best of the <br />Contractor's knowledge, information and belief the Work covered by <br />this Application for payment has been completed in accordance with <br />the Contract Documents, that all amounts have been paid by the <br />Contractor for Work for which previous Certificates for Payment were <br />issued and payments received from the Owner, and that current <br />payment shown herein is now due. <br /> <br />CONTRACTOR: <br /> <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on on-site <br />observations and the data comprising the above application, the <br />Architect certifies to the Owner that to the best of the Architect's <br />knowledge, information and belief, the Work has progressed as <br />indicated, the quality of the Work is in accordance with the <br />C -~ct Documents, and the Contractor is entitled to payment of the <br />A~.. JNT CERTIFIED. <br /> <br /> Application is made for Payment, as shown below, in connection <br /> with the Contract. Continuation Sheet, AIA Document G703, is <br /> attached. <br /> 1. ORIGINAL CONTRACT SUM <br /> (Column A on G703) <br /> 2. NET CHANGE BY CHANGE ORDERS <br /> (Column B on G703) <br /> 3. CONTRACT SUM TO DATE <br /> (Line 1 plus Line 2) <br />4. TOTAL COMPLETED & STORED TO DATE <br /> (Column G on G703) <br />5. RETAINAGE <br /> a. 5% % of Completed Work $1,434 <br /> (Column D + E on G703) <br /> b. 5% % of Stored Material $0 <br /> (Column F on G703) <br /> Total Retainage (Line 5a + 5b IORI $1,434 <br /> Total in Column J of G703) <br />6. TOTAL EARNED LESS RETAINAGE $146,063 <br /> (Line 4 less Line 5 Total) <br />7. PREVIOUS CERTIFICATES FOR PAYMENT $44,595 <br /> (Line 6 from prior Certificate) <br />8. CURRENT PAYMENT DUE $101,468 <br /> (Line 6 less Line 7) <br />9. BALANCE TO FINISH, PLUS RETAINAGE $2,142,141 <br /> (Line 3 less Line 6) <br /> <br />$2,288,204 <br />$0 <br />$2,288,204 <br />$147,497 <br /> <br />State oP.. Minnesota <br />Subscribed and sworn to before me this~°'~y ofCCP, i996 . <br />Notary Public: ~,~t.~ (',t- ~:~¢.l)-dt..:.l'-~ County of: <br />My Commission expires: ' ~:~,p~,.~. 3 i <br /> <br />NOTARY: ~IJ~TER! ANNE BARNE'I'r~ <br /> ~.~._,~l~..J NOTARY PUSUC - MINNESOTA ~ <br /> ;~ "<'-~ MY ~ Ex~re~ Jan. 3 ~, 2000~ <br /> <br /> <br />