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_ J I <br /> APF OATION AND CERTIFICATE FOR PAYI\ *r AIA DOCUMENT G702 PAGt OF PAG(S <br /> PROJECT: St. Anthony Liquor Addition ARCi-ii uCT: B W B R Architects <br /> (n a m c, address) <br /> ARCHITECT'S PROJECT NO: <br /> TO (Owner) City or St. Anthony CONTRACTOR: Fullerton Wilber Co. <br /> CONTRACT FOR: <br /> APPLICATION DATE: ) c�1�0�� APPLICATION NO: <br /> Al TN: PERIOD FROM: J�� I�f `> TO <br /> CHANGE ORDER SUMMARY Application is made for Payment, as shown below, in connection with the Contract. <br /> Conlinualion Sheel,AIA Document G702A, is attached. <br /> Change Orders approved ADDITIONS S DEDUCTIONS $ <br /> in previous months by The present slaltJs of the account for this Contract is as follows: <br /> Owner— <br /> TOTAL <br /> SuhsrquentChangeOrders ORIGINAL CONTRACT SUM . . . . .. . . . . . . . . . . . . . . . .$ 288,5UO.00 <br /> PJUrnhrr A <br /> (dale)e) Net change by Change Orders .$ f'� <br /> i <br /> o , 8-) a OL, 3°" <br /> CONTRACT SUM TO DATE.: <br /> TOTAL COMPLETED & STORED TO DATE . . . ..; . .. .$-L1 <br /> (Column G on G702A) E.3�Sj_7__1 , <br /> TOTALS _ RCTAINAGC �4";.. . . . . . . . . . . . . . . . . . <br /> Nel change by Change Ordcfs $ 1,, f or as noted in C-910i'r1n t on G702A .2 .S 1 9Sd <br /> TOTAL EAR wP TAINAGE . . . . . . . . . . . . . .. .. <br /> Stale of: County of: `( S <br /> The undersigned Contractor certifies that the Work covered by this Appli- L 'B+��I G Vb�aFIG�'LES�FOR PAYMENT . . . . . . . .$� <br /> cation for Payment has been completed in accordance with the Contract - P, Qv e <br /> Documents, that all amounts have been bald by him for work for which <br /> previous Cerlihcales for Payment were issue.d and payments received from ;w:::; ui� pPt t .,VAQ'�*{fJT'DUE $ <br /> uhe Owner, and that the current payment shown herein is now clue. <br /> ifscrjlstiifancl sw rn Io before me Iluisda of 19 <br /> Cnnlrac r: ter- y <br /> b •'Notary Public: , <br /> ter• <br /> B)': Dale: My Commission expires. <br /> a <br /> In accordance will tl e Contract and this Application for Payment life Contractor is entitled to payment in the amount shown above. ❑ OWNER <br /> Architect: (14 le--P, ❑ ARCHITECT <br /> • f' `` SG.,a►- (4+(13 8 -1.°- ❑ CONTRACTOR <br /> ny: )v ❑ <br /> This Cerlificalr. is no nr;oliahle. I is payal a only to the payee named hr.rein and its issuance, payment and acceptance arc wilh(1ul wejudice lo any rights of the Owner or Contractor <br />under their Contract. <br /> AIA f)Or:UMI.NT 6102 AI'1'll(:ATI AND (IRIIFICAlr. 101( I'AYMI:NT • MARCH 1971 I:DICION • AIA(1) <br /> 1'171 • IIII Ah1fRIC:AN INSII11,11F 01" AP01117I.CIS, 17)5 NIAV Y()I(K AVI:., N.1'V„WASIIIN(:I(1N,I). C.211006 1 <br />