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APP CATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 SAG TO (Owner): y Anthony C i t of St. Anthon PROJECT: section "A" St. Anthony APPLICATION NO: 2 Distribution to: f 3301 Silver Lake Road Blvd. SAP 161-106-05 0 OWNER St. Anthony, MN 55418 Section "B" Kenzie Terrace PERIOD FROM: June 1 , 1988 ARCHITECT TO: June 30, 1988❑ CONTRACTOR O ATTENTION: Ricke Carroll Mueller & Assoc. CONTRACT FOR: Blvd. grading & paving ARCFIITECT'S O 10901 Red Circle Drive Street Improvements PROJECT NO: 861019-1 d Minnetonka , MN 55343 CONTRACT DATE: M 4 198IR CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contrac \ — Continuation Sheel,AIA Document G703, is attached. U. CHANGE ORDER SUMMARY Tile present status of the account for this Contract is as follows: Change Orders approved ADDITIONS I DEDUCTIONS ORIGINAL CONTRACT SUM eti in previous months b} I I . . . . . . . . .. . . . . . . . . . . ...S rziv- ;lp�-r�� Owner • TOTAL � Net change by Change Orders . . . . . . . . . . . . . . . . . . . . .S 0.00 Approved this .%lunth Number D ale Approved I CONTRACT SUM TO DATE • S 256, )83.67 ! TOTAL COMPLETED & STORED TO DATE z�17 7 Z7.Sq (Column G On G703) /Z X0.38 RETAINAGE 5 io . . . . . . . . . . . . . . . . . . . . . . . . . S - -- TOTALS or total in COlUmn I on Z G%03 ` •- Net change by Change Orders — TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . . . . .$ ti The undersigned Contractor certifies that to the hest of his knowledge LESS PREVIOUS CERTIFICATES FOR PAYMENT . . . . . . . S 61 ,117.09 information and belief the %Vork cusered by Ihrs Application for - Payment has been completed in accordance s%!ih thi• Contract Docu- ments, that all amounts have been paid bs Ill:!, rur }Vurk tor which f7t/ 2-Z14A 7..A previous Certificates for Payment were issued and payments received, from the Osvner, and that current pagmrnt sho%%n lit-win is now dui .�L CURRENT PAYMENT DUE . . • • • , • • . S r LYL,1 P OLAFSO`f CONTRACTOR: JNES OTA State of:P1110I(;-- , . Count / y Of: 1 '1-: ' ANOKA COIINIY rly COMM EXPIRES APR 2. 199;' Subscribed and sworn to before me this -; :' y of 19 Date: 6-30-$l�ww AAAA,v• Notary Public:, �rl,i � r,.'f! My Commis�iorT-expires: • ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED In accordance ss ith the Contract Documents, based on on-site obser• (Attach explanation if amount cer fed differs from the amount applied for.) /`----- t vations and the data comprising the abuse application, the Architect ARCHITECT: certifies to the Owner that the Work has pfogressed to the point indicated; that to the best of his knowledge, inurrmatrun and belief, s the quality of the Work is in accordance scrth the Contract Docu• Oy' Date: menu;and that the Contractor is entitled t0 pa}ment of 111e A,�10UNT This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor CERTIFIED. 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 APRIL 1978 EDITION .q1,1+ p THE AMERICAN INSTITUTE Of ARCHITECTS 1715 NE1Y Y�QV art.„r �_ 1978