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'PLICATION AND CERTIFICATE FOR PAYMENT AIA Document AdEhL 1OW, City Of St. Anthony PROJECT: ST. ANTHON`f COMMUNITY CENTER APPLICATION NO: 6 DISTRIBUTION TO: 366-01 Silver Lake Rd. OWNER St. Anthony, MN 55418 PERIOD TO: 06130/96 ARCHITECT _CONTRACTOR M (CONT):' GRAUS CONSTRUCTION . VIA (ARCHITECT): Williams/0'Brien Assoc. ARCHITECT'S P.O. BOX 34 PROJECT NO: _ HASTINGS, MN 55033 "RACT FOR: General Construction CONTRACT DATE: 10/224/95 Application is made for Payment, as shown below, in connection NTRACTOR'S APPLICATION FOR PAYMENT with the contract. Continuation Sheet is attached. 'NEE ORDER MARY 1 1. CRI6INAL CONTRACT SUM ........................ f 3151900.00 --- -----------=-------------------1 2. Net Change by Change Orders f 4862.00 .................. ange Orders approved in I ADDITION I DEDUCTION 1 3. CONTRACT SUM TO DATE ..........................f 3156762.00 evious months by owner I 1 1 4. TOTAL COMPLETED 3 STORED TO DATE ............. f 827984.00 TOTAL 1 4862.00 1 1 (Column G ) ---------------------------------- --------1 5. RETAINAGE: proved this Month I I I a. 5.00 % of Completed Work f 413.,'9.0 --- --------I I I (Column D+E ) tuber (Date Approved I I I b. 5.00 % of Stored Material $ 60.00 I I I I (Column F) I I I I Total Retainage (Line 5a+5b) or -----------=-------------------------------I (Total in Column 1) ..:................... f 41399.20 TOTALS I 1 1 6. TOTAL EARNED LESS RETAINAGE .................. f 786584.80 ------ _--_____--__—____ _ _1 (Line 4 less Line 5 Total) t Change by Change Orders i 4862.00 1 7. LESS PREVIOUS CERTIFICATES FOR ------------------------------------------------------I PAYMENT (Line 6 from prior Certificate) .. $ 573309.80 undersigned Contractor certifies that to the best of the Con— B. CURRENT PAYMENT DUE ........................... f 21375.00 ,=tor's knowledge, information, and belief the Work covered by 9. BALANCE TO FINISH, PLUS RETAINA6E .............f 2370177.20 Application for Payment has been completed in accordance with (Line 3 less Line 6) Contract Documents, that all amounts have been paid by the Con— =tor for Work for which previous Certificates for Payment were .Ted and payments received from the Owner, and that current pay— ,....,, J(a%L M. CaAZ shown herein is now due. ------- ---NeT-+Rr-Ptt9ve— sef*-- ---------------- . ��' MY COMMISSION EXPIRES •..� JANUARY 31,2000 TK.CTOR:GRAUIS CONSTRUCTION State of M� "Sworn County of:law n Subscribed ano befor me this ,"day ofu ,19"_,10 Notary Public .�� J Date: / My Commission expires: --�1 1 AMOUNT CERTIFIED .................._...... _. $ C H I T E C T I S C E R T I F A T E F O R P A Y M E N T (Attach explanation if amount certified differs from the amount applied for.) -xordance with the Contract Documents, based on on—site observa— ARCHITECT Williams/ ie oc. -:� and the data comprising the above application, the Architect zi to the Owner that to the best of the Architect's know— By: Date: - 0- nation, and belief the Work has progressed as indicated, Certificate is not negotiable. The AMOUNT CERTIFIED is qua y of the Work is in accordance with the Contract Documents, able only to the Contractor named herein. Issuance, pay= tt;e Contractor is entitled to payment of the AMOUNT CERTIFIED: ent and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this contract.