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P.-PPLICATION AND CERTIFICATE FOR PAYMENT AIA Document TO (OWNER): City Of St. Anthony PROJECT: ST. ANTHONY COMKJNUTY CENTER APPLICATION NO: 11 DISTRIBUTION TO: 3301 Silver Lake Rd. _OMER - • St. Anthony, MN 55418 PERIOD TD: 13/31/96 ARCHITECT _CONTRALTDR FROM (CONT): BMW CONSTRUCTION VIA (ARCHITECT): Williams/O'Brien Assoc. ARCHITECT'S 366 HIGHWAY 61 N. PROJECT NO: _ HASTINGS, MN 55833 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. 1- !CHANGE ORDER SUMMARY 1 1. ORIGINAL CONTRACT SUM ........................ I 3151900.00 1 2. Net Change by Change Orders .....I LI.�&I(:�.OQ I *m?t. cy+•a :Change Orders approved in I ADDITIONS I DEDUCTIONS 1 3. CONTRACT SUM TO DATE .........is Al 49ft 4,g4i 4269G71. 4us !previous months by owner I 1 1 4. TOTAL COMPLETED b STORED TO DATE i TOTAL 1 108471.00 1 1 (Column 6 ) I-- 1 5. RETAINAGE: (Approved this Month I I I a. 5.00 % of Completed Work I X58 IZ 3,10`.50 SdD I I I (Column D+E ) (Number (Date Approved I I I b. 5.00 % of Stored Material I 468.08 7L,'Lo15.dd Jpz I I I I I (Column F) I I I I Total Retainage (Line 5a+56) or I- — 1 .(Total in Column I) .......1Xi 3114A.. I I TOTALS I I 1 6. TOTAL EARNED LESS RETAINAGE ... I -22685i8.50 I►Z -- I (Line 4 less Line 5 Total) IN nge by Change Drders I 108471.00 1 7. LESS PREVIOUS CERTIFICATES FOR {.q I- ---- —I . PAYMENT (Line 6 from prior Certificate) .. I ;125ii:-BR' T e undersigned Contractor certifies that to the best of the Con- B. CURRENT PAYMENT DUE .......................... I 396003.70 tractor's knowledge, information, and belief the Work covered by 9. BALANCE TO FINISH, PLUS RETAINAGE .119A SAS this Application for Payment has been completed in accordance with (Line 3 less Line 6) -.he Contract Documents, that all amounts have been paid by the Con- tractor for Work for which previous Certificates for Payment were :asued and payments received from the Owner, and that current pay- nt shown herein is now due. M►��II11i�11,1� CONTRACTOR:GRAUS CONSTRUCTI State of: M' - County of: Iko{A Subscribed an ;�°rn to before ■e this b day of(b0 ,199(0 Notary Public:l'fv� h, M • cj V'�"'� ;y; Date. /l l� My Commission expires: X v 31��op --- AMOIKCERTIFIED ............................... 1 3%,003 36 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 N E N T (Attach explanation if amount certified differs from the amount applied for.) 1n accordance with the Contract Documents, based on on-site observa- ARCHI"Williams/O!Brien A soc. 3tions and the data comprising the-above application, the Architect :ertifies to the Owner that to the best of the Architect's know- By: Date ledge, information, and belief the Work has progressed as indicated,_ egotiable. The AUNT CERTIFIED is the quality of the Work is in accordance with the Contract Documents, yactor named herein. Issuance, pay- an*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.