Laserfiche WebLink
'1 <br /> APPLICATION FOR PAYMENT NO. F fteen Y <br /> • To City of St. Anthony (OWNER) <br /> Contract for Temporary Granular Activated Carbon System <br /> OWNER's Project No. --- ENGINEER's Project No. <br /> For Work accomplished through the date of <br /> CONTRACTOR's Schedule of Values Work Completed <br /> ITEM <br /> Unit Price Quantity Amount Quantity Amount <br /> 1. Furnish & Install $ $ $ <br /> Treatment System 124,600.00 Lump Sum 124,600.00 100% 124,600.00 <br /> 2. Service Fee 108.00 500 Day 54,000.00 404 43,632.00 <br /> 3. VOC Removal 850.00 80 Pounds 68,000.00 58.92 lbs 50,082.00 <br /> 4. Extra GAC 25.3 1600 cu/fl 40,480.00 0 --- <br /> 5. Remove Equipment 38,650.00 Lump Sum 38,650.00 0 --- <br /> Total(Orig.Contract) 325,730.00$ $218,314-00 <br /> C.O. No. 1 <br /> C.O. No.2 <br /> • Accompanying Documentation: GROSS AMOUNT DUE $218,314.00 <br /> LESS %RETAINAGE g None <br /> Invoice No. 960807301 AMOUNT DUE TO DATE ... ............... $218,314.00 <br /> LESS PREVIOUS PAYMENTS ................ $168,232.00 <br /> AMOUNT DUE THIS APPLICATION .......... $ 50,082.00 <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 , 19 CONTRACTOR <br /> By <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated September 13 19 89 R*e4ro,1lnl]4f Associates, Inc. <br /> •: ' E 1 EER <br /> By <br /> EJCDC No. 1910-8-E(1983 Edition) <br /> Prepared by the Engineers'Joint Contract Documents Committee and endorsed by The Associated General Contractors of America. <br /> Rested sns <br />