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APF .WATION AND CERTIFICATE FOR PAYN.J,T AIA DOCUMENT 6702 PAGI: OF PAGES <br /> PROJECT: St. Anthony Liquor Addition ARCHITECT: B W B R Architects <br /> (name, address) <br /> ARCHITECT'S PROJECT NO: <br /> TO (Owner) City of St. Anthony y CONTRACTOR: Fullerton Lumber Co. <br /> CONTRACT FOR: <br /> APPLICATION DATE: I/o�7/a APPLICATION NO: I,�sutc �rlm <br /> ATTN: PERIOD FROM: )A):2C'1R TO )1a71� <br /> CHANGE ORDER SUMMARY Application is made for Payment, as shown below, in connection with the Contract. <br /> Continuation Sheet,AIA Document G702A, is attached. <br /> Change Orders approved ADDITIONS $ DEDUCTIONS $ <br /> in previous months by The present status of the account for this Contract is as follows: <br /> O%vner— <br /> TOTAL ORIGINAL CONTRACT SUM . .. . ... .. . ...... ......$ 288,500.00 <br /> Suhsettur:nl ChangeOrdas <br /> Numhr:r Apprtrvetl Net change by Change Orders .. . .. ... .. .. ... ... .$ s � <br /> �5 <br /> Idalc) <br /> 1 10 a,,°6 21 <br /> o <br /> I I Ia5/8 (0 cJ j CONTRACT SUM TO DATr. . . . . ... . . .. .. ... ... . ...$ a9 y, a�S <br /> 3 la,/aaJn a y 667 <br /> LI SS O TOTAL COMPLETED & STORED TO DATE ..... .... .$ aq r"I�c 1X00 <br /> (Column G on G702A) o0 <br /> TOTALS RETAINAGr: S % .. .... ..... . .. .. .. .......$ <br /> s� 7 �1 or as noted in Column I on G702A _ <br /> Net change by Change Order: S no <br /> TOTAL EARNED LESS RETAINAGE .. .. ... ... ...... ..$ CD 1a> r�� �L <br /> Stale of: County of: <br /> Od <br /> The undersigned Contractor certifies that llte Work covered by tills Appli- LESS PRE VIOU TES FOR PAYMENT . .. .. .. .$ s�95� <br /> cation for Payment has been completed in accordance with the Contract I)ocumenis That all amounts have been pall by him for Work for which =�n <br /> previous Certificates for Payment were issued and payments received from I,Rw,' ��(DU,r, .. .. ... ... ...... .. ....$ <br /> the Owner, and that the current payment shown herein is now due. 9a <br /> P �G Ma'' say <br /> �e��aArl..svJ(Prs in'licfore me this Z'7 day of �AfG✓J, 17 � <br /> Contra I j 1 / v��A'�'f NoIJ:y Paui'ic: j�G ,D,�v�yj�1�dcyr,/'r✓ <br /> wt�';�`i MBA C.omrstission expires: <br /> Ity: \� Date: I 8 8 ,'. ._� v6v✓/, /y J/ <br /> In accordance with the/ ontract and this Application for Payment the Contractor is entitled to payment in the amount shown above. OWNER <br /> Architect: I ARCHITECT <br /> ❑ CONTRACTOR <br /> ny• ❑ <br /> This Cemlicate is not ne, tatsle. It Is payahl only In the payee named herein and its Issuance, payment and acceptance are without prejudice to any rights of the Owner or Contractor <br />under (heir Contract. <br /> AIA 1)0f.Utitl,NT 6702 • AI'1'IIC•ATIOIJ AND 0.14111'ICAlf. 101( I'AYMI'NT • MARCH 1'171 1,1)Ill(.)N • AIA ) <br /> w 1971 . 1111 ANURICAN INSIII111E or ARCII11LC15, 1735 NI W Y()ItK AVr:.,N.W.,WASI IIN(;I()N,U.C.2110116 J <br />