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APPLICATION FOR PAYMENT NO. Twenty-two <br /> To Ci ty 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 March 31 1990 <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 54,000.00 616 66,528.00 <br /> 3. VOC Removal 860.00 80 Pounds 68,000.00 76.69 lbs: 65,186.00 <br /> 4. Extra GAC 25.30 1600 cu/ft 40,480.00 0 0.00 <br /> 5. Remove Equipment 38,650.00 Lump Sum 38,650.00 0 0.00 <br /> Total (25,730.00 56,314.00 <br /> (Orig.Contract) <br /> C.O. No. I <br /> C.O. No. 2 <br /> • Accompanying Documentation: GROSS AMOUNT DUE $256,314.00 <br /> LESS 67o RETAINAGE ................... $ one <br /> invoice No. 960969801 AMOUNT DUE TO DATE ..................... t256,314.00 <br /> LESS PREVIOUS PAYMENTS ................ $252,966.00 <br /> AMOUNT DUE THIS APPLICATION ......... $ 3,348.0 <br /> CONTRACTOR'S Certification: <br /> The undersigned CONTRACTOR certifies that (I) 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 <br /> CONTRACTOR <br /> By <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated March 29 . 19 90 RIE C A LL MULLU ASSOCIATES, INC. <br /> E NEER <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 /> Rspn.t,t,l13 - <br />