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r <br /> i n. . 64%n, ♦vn , vn 1 pill 16111 - W11LIIIUCN <br /> TotaI. I'Contract Amount S 189,700.00 Total Amount Earned s 188,145.00 <br /> i <br /> Material Suitably Stored on Site, Not Incoporated into Work s <br /> Contract Change Order No. 1 Percent.Complete 100% s (3,800.00) <br /> 1wontract Change Order No. Percent Complete $ <br /> Contract Change Order No. Percent Complete $ <br /> Pu Mr Stwnow M a_Tc•R VAv �--r <br /> I C.45. o° 18 13 00, o o GROSS AMOUNT DUE. ... .. ... . .. . . . s 184,945.00 <br /> $� %b 3 2 .'L S 0)1 S. oo LESS 5 % RETAINAGE. .. . . .. .. $ 9,247.25 <br /> 1-3-B) 312.1 S 1 '"1 3 8% •c AMOUNT DUE TO DATE.. . . . .. . . . . . . $ 175,697.75 <br /> 15o� 'Zi�o. 5° 1 -1 � '�gS ,o•o v <br /> LESS PREVIOUS APPLICATIONS. . . . . = 167,665.50 Of <br /> $, c 3 7-.Z 5 — o -- AMOUNT DUE THIS APPLICATION. . . . $ 8,032.25 <br /> CONTRACTOR'S AFFIDAVIT <br /> The undersigned ontractor hereby swears under oena1ty of perjury that (1) all previous progress. <br /> payments received from the Owner on account br work performed under the contract referred to <br /> above have been applied by the undersigned w'di scharge in full all obligations of the under- <br /> signed incurred in connection with work coverea by prior Applications for Payment under said <br /> contract, and (2) all <br /> material and equipment incorporated in said Rrbdi ect' or otherwise listed in or covered by this <br /> Application for Payment are free and clear di sAA liens, claims, security interests and <br /> encumbrances. <br /> �ted 3-21 19 89 Newmech Coinpanies , Inc. <br /> ontra for <br /> By <br /> Na and T, e-T Wayne Henquinet <br /> Controller <br /> COUNTY OF Ramsey SS <br /> STATE OF Minnesota <br /> Before me on this ,�/ day of 19 8"� personally appeared <br /> ,L. �. known to me, w being TuTy sworn, did depose <br /> and say that 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 the AAMRen�ts contained therein are true, correct and complete. <br /> AAA <br /> KARL P.WOHLERS + <br /> fly Commission Exp i r NOTARY PUBLIC-NiNNESOTA (Notary <br /> WASHINGTON C Public) <br /> MY Comm.Eat P' O OU�T 9!3 <br /> The undersigned has checked the nwzs�,Appl i cation 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 /> i <br /> accordance with the Contract, the undersigned approves payment to the Contractor of the <br /> unt Due. <br /> SHORT ELL HEND C INC. <br /> Date �AAJ <br /> Paqe 3 of 3 <br />