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APPLICATION FOR PAYMENT NO. One <br /> • To City of St. Anthony (OWNER) <br /> Contract for Temporary Granular Activated Carbon System <br /> OWNER's Project No. --- ENGINEER's Project No. 861908-3 <br /> For Work accomplished through the date of July 29, 1988 <br /> ITEM CONTRACrOR's Schedule.of Values Work Completed <br /> Unit Price Quantity Amount Quantity Amount <br /> 1. Furnish & Install $ $ $ <br /> Treatment System 124,60Q.00 Lump Sum 124,600.0 100% 124,600.00 <br /> 2. Service Fee 108.00 500 Day 54,000.0 0 --- <br /> 3. VOC Removal 850.00 80 Pounds 68,000.0 0 --- <br /> 4. Extra GAC 25.30 1600 cu/ft 40,480.0 0 --- <br /> 5. Remove Equipment 38,650.00 Lump Sum 38,650.0 0 --- <br /> Total s325,730.0( 124,600.00 <br /> (Orig. Contract) <br /> C.O. No. 1 <br /> C.O. No. 2 <br /> • Accompanying Documentation: GROSS AMOUNT DUE ....................... X124.600.00 <br /> Invoice No. 960520601 LESS %RETAINAGE ................... $ None <br /> AMOUNT DUE TO DATE ..................... $124,600-nn <br /> LESS PREVIOUS PAYMENTS ................ $ None <br /> AMOUNT DUE THIS APPLICATION ......... t 2,600.00 <br /> CONTRACTOR'S Certification: <br /> The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER on account of <br /> Work done under the Contract referred to above have been applied to discharge in full all obligations of CONTRACTOR <br /> incurred in connection with Work covered by prior Applications for Payment numbered 1 through inclusive; and <br /> (2) title to all materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for <br /> Payment will pass to OWNER at time of payment free and clear of all liens, claims, security interests and encumbrances <br /> (except such as covered by Bond acceptable to OWNER). <br /> Dated I , 19 'fin. <br /> CO CTOR <br /> BY <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> 19 <br /> Dated . August 8 88 Rieke roll Muller sociates Inc. <br /> , <br /> v <br /> By <br /> EJCDC No. 1910-8-E(1983 Edition) Q�C% <br /> Prepared by the Engineers'Joint Contract Documents Committee and endorsed by The Associated General Contractors of America. f <br />