#03 - City Center-Public Works Pay Request 12

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APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702/CMa PAGE ONE OF 2 PAGES APPLICATION NO:09 Distribution to: OWNER PERIOD TO: 12/31/22 LABOR X CONSTRUCTION PROJECT NO.: 21725 MANAGER ARCHITECT CONTRACT DATE:11/04/21 CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application 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 Continuation 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. 1. ORIGINAL CONTRACT SUM $366,400.00 2. Net change by Change Orders $4,245.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 ± 2) $$370,645.00 4. TOTAL COMPLETED & STORED TO DATE $327,427.50 (Column G on G703)By: Date: 5. RETAINAGE: a.5.0 % of Completed Work $16,371.38 State of: Minnesota County of: (Column D + E on G703)Subscribed and sworn to before me this day of b.0.0 % of Stored Material $0.00 Notary Public: (Column F on G703)My Commission expires: Total Retainage (Lines 5a + 5b or Total in Column I of G703) $16,371.38 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $311,056.13 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 Less Line 5 Total)comprising the application, the Construction Manager and Architect certify to the 7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has PAYMENT (Line 6 from prior Certificate) $301,461.13 progressed as indicated, the qualtity of the Work is in accordance with the Contract 8. CURRENT PAYMENT DUE $9,595.00 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE $59,588.88 (Line 3 less Line 6)AMOUNT CERTIFIED $ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied for. Initial all Total changes approved figures on this Application and on the Continuation Sheet that changed to conform to the in previous months by Owner $4,245.00 $0.00 amount certified.) CONSTRUCTION MANAGER: Total approved this Month $0.00 By: Date: ARCHITECT: TOTALS $4,245.00 $0.00 By: Date: NET CHANGES by Change Order 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/CMa · APPLICATION AND CERTIFICATION FOR PAYMENT · CONSTRUCTION MANAGER-ADVISER EDITION · 1992 EDITION · AIA · ©1992 G702/CMa - 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity $4,245.00 Lake Elmo City Center & Public Works Addition Minneapolis, MN 55432 VIA CONSTRUCTION MANAGER: VIA ARCHITECT: Park Construction Company 1481 81st Ave NE TO CONSTRUCTION MANAGER: PROJECT: H+U Construction 5555 West 78th Street, Suite A CONSTRUCTION MANAGER-ADVISER EDITION Minneapolis, MN 55439 FROM CONTRACTOR: 12/20/2022 Hennepin 20 December 9,595.00 12/28/22