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APP(CATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO (Owner): C i tV of St. Anthony PROJECT:Section "A" St. Anthony APPLICATION NO: 3 Distribution to: 3301 Silver Lake Road Blvd. SAP 161-106-05 ❑ OWNER ' St. Anthony; MN 55418 Section "S" Kenzie Terrace PERIOD FROM: 7-1-1988 ❑ ARCHITECT �. TO:9-1-198,9 ❑ CONTRACTOR AT 1'1\.: H. .Coutsr:.lilhos El ATTENTION: Rieke Carroll Mueller & Assoc. CONTRACT FOR:RIvd. Grading and av- ARCHITECT'S T 10001 RPd Circle Drive i ng Street Improvements PRO1EC No: £361019-1 Mi nret,ninka , MN 5F)34.,, CONTRACT DATE: P1a y 4, 1988 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: Change Unlern approved ADDITIONS I DEDU('IIONS 0 ORIGINAL CONTRACT SUM . . . . . . . S256 983-G7 in previous months by (� r n r v Nct change b Change Orders . . . . .. . .$ 3,1197.09 :\ppnoved this Month � r ----- 198 CONTRACT SUM TO DATE 0 7;, tiumher Dale Approved 6 52�1�, - ---- a . 1 R-7.i-i�3 3497.09 I c ,As�'�t`O AL COMPLETED & STORED TO DATE . . . .. . . . ... . 7-.x882.78 6,M\111A (Column G on 6703) .. 840.00 30 Hp RETAINAGE 5 % . . . . . . . . . . . . . . . . . . . . . . . ..$ �• 1 Z:9-12.m or total in Column I on 6703 TOTAt.S TOTAL EARNED LESS RETAINAGE . Z-15897-78 Net change by Change Orders The undersigned Contractor Curuires that to the best of his knowledge. LESS PREVIOUS CERTIFICATES FOR PAYMENT $235,341 .21 information and belief the Work co�cwd by this Application for Payment ha, been completed in accordance \\rlh thr• Contract DoCU- "' mints, that all amounts have been pmd b� him im Work for which Q J prcvious Certificates for Payment were rssucd and payments received CURRENT PAYMENT DUE $ �nS�- �0��:�D•58 . . . . . . . . . . . . . . . . . .. . . .. .. Irum the Ownet, and that Current payment sho\sn herein is now clue. _ CONIRACTOR: *Pending ap roval - regrading as agreed State of:Minnesota Count -e��oIAFSO�i Subscribed and sworn to before me ti Cs Jh da of5° . ) Y NOTt1 PUBLIC-rr•Igt,IESOTA tee. / q_6_88 Notary Public: �' � 4 �', ` ANOYAt t i"" 1'ay Date: My Commission pities: )�� t..,YCOMM EY.Pirt_"PR 2. - ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED . . . .. . . .. . . . . . . . . . . . . . .. . . . . .$ (Attach explanation if amount certified differs from the amount applied for.) In accordance with the Contract Documents, based on on-site obser- ARCHIT CT: � vations and the data comprising the above application, the Architect certifies to the ()wner that the Work has progressed to the point indicated; that to the best of his knowledge, information and belief, By Date: 'Sr`oJ• l the quality of the Work is in accordance with the Contract DOCII- ments; and that the Contractor is enwit-d to payment of the AMOUNT This Certifi,,aj 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 (:LkI111CATE. r(-)R PAYMENT APRIL '1978 EDITION AIA's 19711