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4 <br />APPLICATION FOR PAYMENT NO. 3 04 <br />PROJECT Mounds View/Svsco <br />OWNER City of Mounds View <br />88-15 4-1298 <br />OWNER'a Protect No .......................... ENGINEER's Project No.................. <br />CONTRACTOR .... Lametti E Sons <br />.................................................................. <br />Contract For ..Utilities s Grading Street Set 15 <br />...I............ Contract Date <br />For Work aeecmpllshad through the date of.........July 19, 1989 <br />.......................................... <br />STATEMENT <br />OF WORK <br />517 929.50 <br />Original Contract Amount 5.....'...... <br />Work To Date <br />5....:....,,, <br />488 202.57 <br />Net Change Orders S.— .0...... <br />Amount Retained ( 5 %) <br />5........... <br />24,410.13 <br />Current Contract Amount S..51i:929; 50 <br />Subtotal <br />S. <br />463.792:44 <br />Previous Payments Recommended <br />3. <br />421,332, 86 <br />Amount Due This Payment <br />$. <br />42:459:56 <br />CONTRACTOR's Certification: <br />Th. undorslened CONTRACTOR c.Illlts. that (1) all previous pragrtaa payments Inspired from OWNER en account of work Cana <br />under the Centrsst'.ruled to seer. have been applied to discharge Intuit all obilgallena of CONTRACTOR Incurred In connectlenwllh <br />Work severed by 0111, Applle.t!ece for Payment nembond i through 3 In<lu.iq; and (a) title to .11 material, and equipment <br />Incorporated In ..14 Work or otherwl.o 3,1.4 In or covered by this Application for Payment will pus to OWNER at time of payment <br />Inc and clear of all lions , clanma , ucurlly interests and encumbrances ( except such as covered by Bond acceptable is OWNER ). <br />Dated r, % , 19 <br />J � <br />ENGINEER'S Recommendation: <br />This Application (with accompanying documentation) me.le the requirements of the Contract Documents and payment <br />of the above AMOUNT DUE THIS APPLICATION Is recommended. <br />Dated 7 047 ,9 9 Westwood Profeessssiioonnal Services, Inc. <br />By zl� <br />By <br />