3.5. SR 09-16-1996 - Laserfiche WebLink

Home Browse Search

MORTENSON '~612 520 3430 09/12/96 11'17~:02/03 N0:496 TO (OVVNER): CITY OF ELK RIVER 13065 ORONO PARKVVAY ELK RIVER, MN 55330 · ,~OM (CONTRACTOR,): M,A. MORTENSON COMPANY P.O. BOX 710 MINNEAPOLIS, MN 55440 PROJECT: MAM JOB NO: 951019 ELK RIVER INVOICE NO: 17828 ICE ARENA EXPANSION APPLICATION ~: 4 VIA (ARCHITECT): ARCHITECTS PROJECT NO: Dlstdb~ionto; __OWNER __ARCHITECT __CONTRACTOR PERIOD FROM 08/01/~ TO: 08/31/96 CONTR~.,..CTOR'S___Ap. PLICATION FOR PAYMENT __ Application is made for Payment, as shown below, in connection CHANGE ORDER SUMMARY __ADDITIONS DEDUCTIONS Change Order's approved in previo..,.u,s months .b_y_ O.~_n_er .......... .App._roved .t.h.! ~. M on th Number Date ARproved 1 07/25/g6 Shaw Lundqui~'- 2,514 ................. TOTALS 2,514 0 Net chang_e, by Cham3e Orders 2..51~=== The undersigned Contractor certifies that to the best of the Contractods knowledge, information and belief the Work covered by this Application for payment has been 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 clue. CONTRACTOR: ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-si~a observations and the data comprising/he above application, the Arc--tact certifies to the Owner that to the best of the Architecrs kr ;~ge, information and belief, the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. Date: with the Contract, attached. 1. ORIGINAL CONTRACT SUM (Column A on G703) 2. NET CHANGE ElY CHANGE ORDERS (Column iii on G703) 3, CONTRACT SUM TO DATE (Line I plus Line 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE a, 5% % of Completed Work (Column D + E on G703) b. 5% % of Stored Material (Column F on G703) Total Retainage (Line 5a + 5b JORI Total in Column J of G703) 6. TOTAL EARNED LESS RETAINAGE (Line 4 less Line 5 Total) 7. PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8, CURRENT PAYMENT DUE (Line 6 less Line 7) Continuation Sheet, AIA Document GT03, is $2,288,204 $2,514 $2,290,718 $766,867 $5,918 $5,918 $760.950 $148,063 $614,888 9. BALANCE TO FINISH, PLUS RETAINAGE $1,529,789 ~.- .~ {Line 3 less Line 6_.) , ~. -~ ~ State ot Minnesota Subscrii:)ed and sworn to before me this day of ,1996 Notary Public: County of: My Commission expires: ,2000 NOTARY: TOTAL AMOUNT CERTIFIED $ By: Date: