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APPLICATION AND CERTIFICATE FOR PAYMENT AIA OOCUMENT G702 PAGE UNE OF r!.�s TO (Owner): City of St . Anthony PROJECT: 871Q15 1 APPLICATION NO: Distribution to: 3301 Silver Lake Road Signalized Pedestrian ❑ OWNER St . Anthony, MN 55418 Crossing PERIOD FROM: 5-01-88 ❑ ARCHITECT TO: 5-31-88 ❑ CONTRACTOR El ATTENTION: Lynnette Roshell CONTRACT FOR: ARCHITECT'S ❑ PROJECT NO: 871015 CONTRACT DATE: 12-29-87 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY The present status of the account for this Contract is as follows:1 144 Change Orders approved ADDITIOI¢S DEDUCTIONS ORIGINAL CONTRACT SUM . . . . . . . . . . . .. .. .. . . . .. .$ 67 , 567_09 in previous months by O'.vner TOTAL Net change by Change Orders $ 650. 00 I. Approved this imonth Number Date Approved CONTRACT SUM TO DATE $ 68, 217 . 00 TOTAL COMPLETED & STORED TO DATE . . .. .. . . . . .$ 68 , 217 .00 (Column G on G703) RETAINAGE 9 % . . .. . . . . . . . .. . .. .. . . .. .. .$ 3 , 411 . 00 or total in Column I on G703 TOTALS TOT 64 , 806. 00 AL EARNED LESS RETAINAGE . . . . . . . .... . . .. .. .$ Net change by Change Orders The undersigned Contractor certifies that to the best of his knowledge,. LESS PREVIOUS CERTIFICATES FOR PAYMENT . .. . . ..$ ----- information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Docu- ments, that all amounts have been paid by him for Work for which previous Cer ificates for Payment were issued and payments received CURRENT PAYMENT DUE 64 , 806. 00 from the O •ner,and that current payment shown herein is now due. ..n. Venn 1MAM/v�AAMMMh■ CON T T R: State of: Minne to Conn . � � Subscribed and savor be re th /f dayo ' ► ,1 '. PI!:'LIG-!JIiNNE`.OTA 5-31-8 8 Notary Public: / / � a couid'Y By' e: My Commission expires: ' M;rrn;f•E%P!&L;JIBdE 24 1989 AR HI 'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED . .. . .. ... . . . . . . . . . . .. . .. . . . . .$ �4T � '•` � In accordance with the Contract Documents, based on on-site obser- (Attach explanation if amount certified differs from the amount applied tor.) . C T T: vations and the data comprising the above application, the Architect AR certifies to the Owner that the Work has progressed to the point 6 O indicated; that to the best of his knowledge, information and belief, g the quality of the Work is in accordance with the Contract Docu- y' Date: —1 ments;and that the Contractor is entitled to payment of the AMOUNT This Certl Icate 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 AIA®• ©1978 TFIF Aiirvor 4N INSTITIITr nF Apr'tflTrr'7C i�ir, ,ink, wwv Avr��i it y�,�r :��A ri ii• r-Tn•� n r- "nnnr