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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES �+ TO (Owner): City of St. Anthony PROJECT: 871015 ' APPLICATION NO: 2 Distribution to: 3301 Silver Lake Road Signalized Pedestrian ❑ OWNER St. Anthony, MN 55418 Crossing. PERIOD FROM: 6-1-88 ❑ ARCHITECT TO: 8-1-88 ❑ CONTRACTOR ATTENTION: 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. r . CHANGE ORDER SUMMARY The present status of the account for this Contract is as follows: Change Orders approved ADDITIONS DEDUCTIONS ORIGINAL CONTRACT SUM . . . . . . . . . . $ 67 , 567 .00 . .. . . . . . . . ... in previous months by Owner 650.00 TOTAL Net change by Change Orders . . . . . . . . . .. . .. ..... ..$ Approved this Month 68 217 . 00 CONTRACT SUM TO DATE . . . . ... .. .. ........ .. .. .$ ' Number Dale Approved TOTAL COMPLETED & STORED TO DATE .. . .. ... ...$ 68, 217 .00 (Column G on G703) RETAINAGE 5 % . . . . . . . . . . . . . . .. . . .. . .. . .$ 500. 00 or total in Column I on G703 TOTALS TOTAL EARNED LESS RETAINAGE . . ... .. .. . ... .. .. .$ 67 , 717 . 00 Net change by Change Orders The undersigned Contractor certifies that to the best of his knowledge, LESS PREVIOUS CERTIFICATES FOR PAYMENT . .. . .. .$ 64 , 806. 00 information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract DOCn- ments, that all amounts have been paid by him for Work for which 2 , 911 . 00 previous Certificates for Payment were issued and payments received CURRENT PAYMENT DUE . . . . . .. . . . . . . . . . . .. . ... ..$ from the O vner,and that current payment shown herein is now due. CON State of: Minn ota Count)Pbf.,., J. MANN • Subscribed and s C of m sl7.-day of 1� Notary Public: � , 'NO R. APOBAICO MtTY SOTA By: Date: 7-27-88 My Commission ex tress _Z My COMM.EXPIRES JUNE 29, 1989 AI _ _ CT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED . . . . .. .. . . . . . .. . .. . .. . .. . .Y. .$ (Attach explanation if amount certified differs from the amount applied for.) In accordance with the Contract Documents, based on on-site obser- ARCHI ECT: vations and the data comprising the above application, the Architect certifies to the Owner that the Work has progressed to the point 7 indicated; that to the best of his knowledge, information and belief, B Date: the quality of the Work is in accordance with the Contract Docu- This Cert tale is not negotiable. The AMOUNT CERTIFIED is payable on y to the Contractor CERTI;and that the Contractor is entitled to payment of the AMOUNT named herein. Issuance, payment and acceptance of payment are without prejudice to any CERTIFIED. rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT• APRIL 1978 EDITION AIAS 1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006 G702-1978