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nr . t-A%.^r •Wit r vn r nrr116-611 - 1.UIIt.1!lUCU . <br /> j - S i i 4123—tT0-6fl <br /> �ota�� Contract Amount S 189,700. 00 Total Amount Earned <br /> Material Suitably Stored on Site, Not Incoporated into Work S <br /> �ntract Change Order No. Percent.Complete $ <br /> Contract Change Order No. Percent Complete $ <br /> Contract Change Order No. Percent Complete $ <br /> F--,z V&V LT <br /> oc- GROSS AMOUNT DUE.... ..... $ 114A-10 <br /> 4,of 3• So <br /> LESS 5 % RETAINAGE. .. .. .. .. s --- —W S 733.Sc <br /> 9 3) 7-9o.o° I�� (46.5'fl AMOUNT DUE TO DATE.. ... .. . . .. .. 1o8,93G�' <br /> . <br /> LESS PREVIOUS APPLICATIONS. . . . . $ 66.034.50 <br /> 1� 45.13.0� 11.E "L29.oo <br /> AMOUNT DUE THIS APPLICATION. . . . $ vZ.v <br /> CONTRACTOR'S AFFIDAVIT <br /> TF—eundersigned Contractor hereby swears under penalty of perjury that (1) all previous progress. <br /> payments received1rom the Owner on account of work performed under the contract referred to <br /> above have been apglied .by the undersigned to discharge in full all obligations of the under- <br /> signed incurreda_.connection with work covered by prior Applications for Payment under said <br /> contract, �; r <br /> and (2) all <br /> material and equ1gmept incorporated in said Project or otherwise listed in or covered by- this <br /> Application for PVw' nt are free and clear of all liens, claims, security interests and <br /> encumbrances. <br /> �ed January 27, 19 89 Newmec Companies , Inc. <br /> Contra for <br /> By l <br /> Name` and Ti a Wayne Henquinet :.. <br /> Controller <br /> COUNTY OF SS <br /> STATE OF ) <br /> Before me on this day of , 19 Q 91 personally appeared <br /> nown to me, w o being kTy sworn, did depose <br /> and say tkIt he is the of the Contractor above mentioned; <br /> (Office) <br /> that he executed the above Application for Payment and Affidavit on behalf of said Contractor; <br /> and that all of she tements contained therein are true, correct and complete. <br /> r <br /> ty KARL P.WOHLERS <br /> My Commission E�' NOTARY PUBLIC-MINNESOTA <br /> WASHINGTON COUNTY --T� � �"y Pu l i c <br /> My Comm.Expires Oct.14,1993 <br /> 4 vvvvvv vvvvvvvvvvvvvvvvvvvvvvvvvv v <br /> The undersigned has checked the Contractor's Application for Payment shown above. A part of <br /> this Application is the Contractor's Affidavit stating that all previous payments to him <br /> under this Contract have been applied by him to discharge in full all of his obligations in <br /> connection with the work covered by all prior Applications for Payment. <br /> aaccordance with the Contract, the undersigned approves payment to the Contractor of the <br /> nt Due. <br /> � SHORT E TT H C INC. . <br /> Date 1 1989 <br /> Page 3 of 3" <br />