CC PACKET 10281997 - Laserfiche WebLink

Home Browse Search

I��LICRTION AND CERTIFICATE FOR PAYMENT AIA Document TO (OWNER):—City Of St. Anthony PROJECT: ST. ANTHONY COMMUNITY CENTER APPLICATION NO: 15 DISTRIBUTION TO: 3301 Silver Lake Rd. OWNER St. Anthony, MN 55418 PERIOD TO: 09/30/97 ARCHITECT CONTRACTOR FROM (CONT): GRAUS CONSTRUCTION VIA (ARCHITECT): Williams/O'Brien Assoc. ARCHITECT'S 360 HIGHWAY 61 N. 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. ICHANGE ORDER SUMMARY 1 1. ORIGINAL CONTRACT SLIM ............ .. f 3151900.00 . 12. Net Change by Change Orders .... :.......aR t •1;3f0?7�8 (Change Orders approved in I ADDITIONS I DEDUCTIONS 1 3. CONTRACT SUM TO DATE ........ XSIV 2I A OR.t &28292-:0 (previous months by owner I 1V1IIK 1 1 4. TOTAL COMPLETED b STORED TO DATE 12.t34. $.14:0 i 4263163:00 I TOTAL I '�- .r0 I I (Column G ) I- ------ ------------- ---- --I 5. RETAINAGE: (Approved this Month I I I a. 5.00 % of Completed Work f .00 I_ ___----_ ___1 I I (Column D+E ) INuvber (Date Approved I I I b. 5.00 % of Stored Material f .Q+O I I I I I (Column F) I 3 _I I _ --------1—2-11(-M I Total Retainage (Line 5a+5b) or --------=------ - -----I (Total i n Column I) ...................... I 20cm .00 ............. TOTALS I (l C(1114 1 2'7l 1.00 1 6. TOTAL EARNED LESS RETAINAGE .Cq I-------------=- --------- --- --I (Line 4 less Line 5 Total) (Net Change by Change Orders 1 431027.00 (1(o,34-6.01J 1 7. LESS PREVIOUS CERTIFICATES FOR I --------- ----------------- -I PAYMENT (Line 6 from prior Certificate) .. f ;3,1£31,580.00 .The undersigned Contractor certifies that to the best of the Con- 8. CURRENT PAYMENT DUE ........... P�. :9.`�:°.°.. i FrYS$3:60 tractor's knowledge, information, and belief the Work covered by 9. BALANCE TO FINISH, PLUS RETAINAGE 3l1-.14:..t -f97fr4-w :.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 ° issued and payments received from the Owner, and that current pay- ?�azt L'ngift P Y 1 P y �t:� �� NOTARY PUBLIC-MINNESOTA vent shown herein is now due. -------- _ y-eeNMxt 3JUN 4APIRES — JANUARY 31,20 CONTRACTOR:GRAUS CONSTRUCTION State of: Minne9ota County of: Ialota Subscribed and Sworn to before ■e da of5ept. ,1997 Notary Publ' By: Date: �d My Commission,exp fres. 1/31/2000 — AMOUNTCERTIFIED ............................... f ?134o4-00 A R C H I T E C T'S C E R T I F 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- ARCHITECT: Williams/O' r•en As r. ations and the data comprising the above application, the Architect -fies to the Owner that to the best of the Architect's know- By: Date: l t information, and belief the Work has progressed as indicated, T Certificate is not negotiable. The AMOUNT CERTI IF ED is t quality of the Work is in accordance with the Contract Documents, a able 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.