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APPWATION AND CERTIFICATE FOR PAYME T A1.1 1)OCUh1ENT G702 PAGE ONE OF 3 PAGE •� TO (Owner): City of St. Anthony PROJECT Section "Art St. Anthony APPLICATION NO: 1 Distribution to: 3301 Silver Lake Road Blvd. SAP 161-106-05 ❑ OWNER St. Anthony, MN 55418 Section "B" Kenzie Terrace PERIOD FROM: May 13, 19880 ARCHITECT TO: May 31 , 19880 CONTRACTOR El ATTENTION Rieke Carroll Mueller & Assoc. CONrRAC:T FOR: Blvd grading and pavillgARCI-ifTECI'S ❑ 10901 Red Circle Drive Street Improvements I'ROJFC:T NO 861019-1 Minnetonka, MN 55343 Attn: H KOutsoumbos CONTRAC I DATE y 4, 1988 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract Continuation Sheet, ALA Document G703, Is attached. CHANGE ORDER SUMMARY { The present status of the account for this Contract is as follows: Change Orders appro%rxl AD01110\s j DIDLI('I ION', ORIGINAL CONTRACT SUM 5256,983.67 in prevmus months by � . . . . . . . . . . . . . . . . . . Oc�ner TOTAL Net Change by Change Orders S 0.00 Z5�O,9 83 do-7 Appruu•fi thn .�tunlh 82�tl-� CONTRACT SUM TO DATE S s Number Date Approved . . . . . . . . . . . . . . . . . . . . . . . . v -- I ' ti. 333.'1�,s i I TOTAL COMPLETED & STORED TO DATE . . . . S 41 i j (Column G on G703) 3216. 9 RETAINAGE 5 % . . . . . . . . . . . . . . . . . . . . . . . . . S �:L -�a Z�' or lotal in Column I on 6703 Co 111 f 7,05 TOTALS' LNethange by Change Urders — -( — -- TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . . . . . 5 7g7=�0 - The undere,gned Contractor certitiv that hI Inc•heSI of his knw,%ledge LESS PREVIOUS CERTIFICATES FOR PAYMENT . . . . . . .S 0.00 intormatwn and belief the \York urxefca by III;, Application for y, Payment has been completed in accordance ,,uh Ili,• Contract Docu- ments, that all amounts have been pail by hun for work fur which �•1L t�1 17.E 1 previous Cerhircates for Payment %%i•re r>.uecl and payments reccrsed CURRENT PAYMENT DUE S- 61 r767_ ' (rom the Owner, and that current navfncnt ehoti%n herein is now du(- + "ri i`r`. L1'Li+ " .11.AFS0 ��t�. _kg,1�e CONT TOR: Nl11AM !'UIIL11. MIIJN UjA of./l /71�1_<yyh ' County of:' f: //�� I AN)KA t,nurlty ur)scribed and sworn to.befow e this �t day of .1�/ � JAY COMM EXPIRES APR f1y.UE1SFy Public: �r �nn-�www�vvvvvvWv0A9oCommissron ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED . . . . . '. . . . . . . . . . . . . . S , ► ► -1.C9 (Attach explanation it amount cerrrire(i drfiers from the amount applied for.) In accordance %c,th the Contract Documents, based on on-sfte obser- vations and the data comprising the abuse application, the Architect ARCHITECT: certifies to the Owner that the Work has progressed to the point indicated; that to the best or his kno%%Ivdge, irrtormauon and belief, 6 ` the quality of the Work is in accordance with the Contract Docu- By. Date: ments; and that the Contractor is entitled to pavment of the AMOUNT This 4(Cerfifica is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor CERTIFIED. named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT APRIL 1118 EDITION ' AIA• • 47 1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE., N 1v., WASHINGTON, D(_ N)",