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APPLICATION FOR PAYMENT NO. 1 <br /> To: City of. St. Anthony, Minnesota (OWNER) <br /> From: day Bros. Inc. (CONTRACTOR) <br /> Contract: Contract ; <br /> .Project: aintenance Work at the G.A.C. Water Filtration Plant <br /> OWNER's Contract No. ENGINEER's Project No. A-000010491.05 <br /> For Work accomplished through the date of: 6/15/99 <br /> 1. Original Contract Price: $ 10.,456.00 <br /> 2. Net change by Change Orders and Written Amendments(+or-): $ 0 <br /> 3. Current Contract Price(I plus 2): $ 10,456.00 <br /> 4. Total completed and stored to date: $ 9,445.98 <br /> 5. Retainage(per Agreement): <br /> 5 %of completed Work: $ 472.30 <br /> %of stored material: $ <br /> Total Retainage: $ 472-in <br /> 6. Total completed and stored to date less retainage(4 minus 5): $ 8,973.68 <br /> 7. Less previous Application for Payments: i--0 <br /> 8. DUE THIS APPLICATION(6 MINUS 7): $ 8,973.68 <br /> Accompanying Documentation: <br /> CONTRACTOR'S Certification: <br /> The undersigned CONTRACTOR certifies that(1)all previous progress payments received from OWNER on <br /> account of Work done under the Contract referred to above have been applied on account to discharge <br /> CONTRACTOR's legitimate obligations incurred in connection with Work covered by prior Applications for <br /> Payment numbered 1 through _ inclusive;(2)title of all Work,materials and equipment incorporated in said <br /> Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of payment <br /> free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond acceptable to <br /> OWNER indemnifying OWNER against any such Lien,security interest or encumbrance);and(3)all Work covered <br /> by this Application for Payment is in accordance with the Contract Documents and not defective. <br /> Dated June 22, 1999 Jay Bros. Inc. <br /> .CONTRACTOR <br /> By: <br /> State of Minnesota Mark Jay, CFO <br /> County of Chisago <br /> Subscribed and sworn to before me this. <br /> day of 22 June, .1999 <br /> JENELL M.JOHNSON _ <br /> i' NOTARY PUBLIC-MINNESOTA <br /> CHISAGO COUNTY <br /> No blic My Cotnmisal0n Endres Jan:31,2 <br /> My Cbinrnission expires: January 31 , 2000 <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated June 17, 1999 <br /> • By:yle:: <br /> EJCDC No. 1910-8-E (1996 Edition) <br /> Prepared by the Engineers Joint Contract Documents Committee and endorsed by The Associated General Contractors of America and the Construction Specification <br /> institute. <br />