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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G1702 PAGE ONE of 3 '� PAGES TO (Owner): City of St. Anthony R J T. cti on "A" St. Anthony ,APPLICATION NO. 4 Distribution to: 3301 Silver Lake Roa (� (1 ( U U d. SAP 161-1.06-05 ❑ OWNER St. Anthony, MN 554 15 IIJJ L5 U U tion "B" Kenzie Terrace PERIOD FROM: 9-1-88 LJ ARCHITECT 'I J FEB 31989 To: 10-1 s-ss 0 CONTRACTOR Attn: H. Koutsoumbos El ATTENTION: ARCHITECT'S Rieke Carroll Mueller & N�P `�lTkk°R: Blvd. Grading & Paving PROJECT NO: 861019-1 ' 10901 Red Circle Dri6� 130 Hopkins, Minn. 353�43Street Improvements Minnetonka, MN 55343 CONTRACT DATE: May 4, 1988 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheel,AIA Document G703, is attached. CHANGE ORDER SUMMARY _ The present status of the account for this Contract is as follows: Change Orders approved ADDITIONS DEDUCTIONS ORIGINAL CONTRACT SUM S 256,983.67 in previous months by Owner TOTAL Net change by Change Orders . . . . . . . . . . . . . . . . . .. . .5 3,497.09 Approved this ,Month — —_ Number Date Approved CONTRACT SUM TO DATE . . . . . . . . . . . . . . . . . . . . . . . . S_260,480.76 1 8-23-88 3497.09 TOTAL COMPLETED & STORED TO DATE . . . . . . . . . . . S 259,649.53 (Column G on G703) R[TAINAGE 0 % S 0.00 or total in Column I on 6703 TOTALS 3497.09 O.GO 259,649.53 TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . . .. .S Net change by Change Orders 3497.09 The undersigned Contractor certifies that to the I)CSI of his knowledge, LESS PREVIOUS CERTIFICATES FOR PAYMENT . .. . . . . S 245,897.79 information and belief the Work covered by this Application for ,e, Payment has been completed in accordance with the Contract Docu- ments, that all amounts have been paid by him for Work for which previous Certificates for Payment were issued and payments received . ,�; ,,:,•.�•;,;��„ .,•;,.;• CURRENT PAYMENT DUE $ 13,751 .74 from the Owner,and that current payment shrnvn herein is now due. Lti'LA P OLAFSQ;d CON CTOR: Ashbach Co�str t10f1rCo. f'`ry NOTARY PI181.1(..-MINNESOstate of: 1V 11?nI50f6L County of: Ra r6e AgOKA COUNTY ,.. Subscribed and sworn to before me Is /� clay of 19 9 / 2-1-89 .• i,iY COMM Cr,?li .,APR 2. Notary Public • (S/ F� ate: r:�tinrnnrw�rwr.rn�. '"Mv Commission Aires: ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . .5 13 7S 11 In accordance with the Contract Documents, based on on-cite obser (Attach explanation if amount certified differs from the amount applied for.)vations and the data comprising; the above application, the Architect ARCHITECT: certifies to the Owner that the Work has progressed to the point indicated; that to the best of his knowledge, information and belief, By Date: S the quality of the Work is in accordance with the Contract Docu- ments;and that the Contractor is entitled to payment of the AMOUNT This Certifi ate is not negotiab'e. The AMOUNT CERTIFIED is payab a 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. r AIA DOCU G702 • APPLICATION AND CERTIFICATE FOR PAYMENT APRIL 1978 EDITION A"� n 190 .THE AMERI INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGT D.C. 20006 702-1978