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J P'LICATION AND CERTIFICATE FOR PAYMENT AIA Document TO (OWNER): City Of St. Anthony PROJECT: Sr. ANTHONY COMMUNITY CM- ,R APPLICATION NO: 7 DISTRIBUTION TO: 3301 Silver Lake Rd. OWNER . St. Anthony, MN 55418 PERIOD TO: 07/31/96 ARCHITECT _CONTRACTOR FROM (CONT): GRAUS CONSTRUCTION VIA (ARCHITECT): Williams/O'Brien Assoc. ARCHITECT'S P.O. BOX 34 PROJECT NO: _ HASTINGS, MN 55033 CONTRACT FOR: General Construction CONTRACT DATE: 10/24/95 Application is made for Payment, as shown below, in connection CONTRACTOR'S APPLICATION FOR PAYMENT with the contract. Continuation Sheet is attached. I I ICIMNGE ORDER SUMMARY 1 1. ORIGINAL CONTRACT SUM ........................ E 3151900.00 i- ------- ---------------1 2. Net Change by Change Orders 88103.00 (Change Orders approved in I ADDITIONS I DEDUCTIONS 1 3. CONTRACT SUM TO DATE ..........................t 3240003.00 (previous months by owner I 1 1 4. TOTAL COMPLETED IL STORED TO DATE ............. i 1049984.00 I TOTAL 1 4862.00 1 1 (Column 6 ) I--- ----------- -----------------I 5' RETAINAGE: (Approved this Month 1 I 1 a. 5.00 % of Completed Work i 521439.20 I---- -----1 I I (Column D+E ) (Number (Date Approved I I I b. 5.00 % of Stored Material 1 .00 I Jeff SEE ATTACHED CHANGE ORDER REPORT fefte 1 (Column F) I I I I 1 Total Retainage (Line Sa+Sb) or — ---=----------------------------------I (Total in Column I) .. 1 52499.20 I TOTALS 1 83241.00 1 1 6. TOTAL EARNED LESS RETAINAGE .................. f 997434.30 I - —I (Line 4 less Line 5 Total) (Net Change by Change Orders 1 88103.00 1 7. LESS PREVIOUS CERTIFICATES FOR I__— I PAYMENT (Line 6 from prior Certificate) .. 1 786584.80 The undersigned Contractor certifies that to the best of the Con- 8. CURRENT PAYMENT DUE .......................... f 210900.00 tractor's knowledge, information, and belief the Work covered by 9. BALANCE TO FINISH, PLUS RETAINAGE .............3 2242518.20 this Application for Payment has been completed in accordance with (Line 3 less Line 6) the Contract Documents, that all amounts have been paid by the Con- tractor for Work for which previous Certificates for Payment were CARLA P REICHENBERG issued and payments received from the Owner, and that current pay- NOTARY PUBLIC-MINNESOTA t Bent shown herein is now due. DAKOTA COUNTY - My Comm. Expires Jan.31,2000 CONTRACTOR:GRAU5 CONSTRUCT State of: /►'�V1eSv Coun y of:-��-- k ! t 6 5ubscri�2nd 5w n for Be t is5 ay of d(�,19 q Notary By: Date: 9� »y Commission expires: ----- ------- ---------------- --- -- ---- -- ----- AMOUNT CERTIFIED ............................... f 461C100.00 A R C H I T E C T'S C E R T I F I C A T E F O R P A Y M E N T (Attach explanation if amount certified differs from the amount applied for.) In accordance with the Contract_.Documents, based on on-site observa- ARCHITECMilliays/alarie ssoc. ations and the data comprising the above application, the Architect certifies to the Owner that to the best of the Architect's know- By: Date: b le, information, and belief the Work has progressed as indicated, ertificalre is not negotiable. The AMOUNT C=RTIFICI) is ...: quality of the Work is in accordance with the Contract Documents, yable only to the Contractor named herein. Issuance, pay- and the 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.