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APPLICAT ` AND CERTIFICATE FOR PAYMENT AIA MENT G702 PAGE ONE OF P TO OWNER: TKD 1500 Piper Jaffray Plaza St. Paul, MN 55101 FROM CONTRACTOR: Carl Bolander & Sons Co. 251 Starkey Street St. Paul, MN 55107 CONTRACT FOR: PROJECT: Century Trail Li on APPLICATION NO: 00007 PERIOD TO: 7/30/2004 PROJECT NOS.: 23 -5290 VIA ARCHITECT: TKDA 1500 Piper Jaffray Plaza St. Paul, MN 55101 CONTRACT DATE: Distribution to: ❑ OWNER ❑ ARCHITECT ❑ CONTRACTOR 0 0 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM . Net change by Change Orders CONTRACT SUM TO DATE (Line 1 ±2) TOTAL COMPLETED & STORED TO DATE (Column G on G703) . RETAINAGE: a. ) % of Completed Work tit h umns D + E on G703) b. 0 % of Stored Material (Columns F on G703) $0.00 $0.00 Total Retainage (Line 5a + 5b or Total in Columns 1 on G703) . TOTAL EARNED LESS RETAINAGE (Line 4 less Line 5 Total) LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) CURRENT PAYMENT DUE BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $0.00 $77,406.00 $2,427.41 $79,833.41 $79,833.41 The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation 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 pay- ments received from the Owner, and that current payment shown herein is now due. CONTRAC . Carl Bolander Sons Co. By: /L • `1 j f �',. i JJ Tim Gillen State of of: Subscribed al sworn to efore me this Notary Public: My Commission expires: ja/ `• St I frj; $0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT Ito4 Date. r `Z(• 'at/ 7/21/2004 JULIE R. FOSSUM NOTARY PUBLIC - MINNESOTA RAMSEY COUNTY My Commission Expires Jan. 31, 2005 $79,83141 In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the $75.841.74 quality of the Work is in accordance with the Contract Documents, and the Contractor $3,991.671 is entitled to payment of the AMOUNT CERTIFIED. HANGE ORDER SUMMARY ADDITIONS DEDUCTIONS 'otal changes approved in revious months by Owner $10,327.00 $0.00 otal approved this Mouth $0.00 $7,899.59 TOTALS $10,327.00 $7,899.59 ET CHANGES by Change Order $2,427.41 AMOUNT CERTIFIED $3,991.67 (Attach explanation ifamount certified differs from the amount applied for. Initial all figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified) ARCHITECT: TKDA By: Date. 7/21/2004 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702. APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA® • 01992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. y�• "This document has been reproduced electronically with the permission of The American Institute of Architects under License 0700310 Pdmavera Systems, Inc. Reproduction of this document without project- spedliic information is not permitted. Contact The American to verify the curenl version of this document and license status.' G702 -1992 Institute of Architects