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AP i -ATION AND CERTIFICATE FOR PAYN k AIA DOCUMENT C702 PACE uNE OF PAGES PROJECT: ARCHITECT: (name, address) St. Anthony Liquor addition 13 W h R Architects � - a ARCHITECT'S PROJECT NO: /l 614E RE TO (Owner) City of St. Anthony CONTRACTOR: Fullerton Wilber Co. CONTRACT FOR: f�l @w G v✓p } rt�G_T,'�� APPLICATION DATE: i a I t-1 ) ;97 APPLICATION NO: ATTN: ,v PERIOD FROM: I Q:))3 f g TO ► a J'-1 I g -� CHANGE ORDER SUMMARY Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G702A, is attached, in previous months by present Orders approved ADDITIONS $ DEDUCTIONS 8 The present status of the account for this Contract is as follows: n pr Owner— TOTAL ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . . . .$ 288,500.00 Suhse.r)uenl Changeorders ^� Ntirnlwr Approvcd Nei change by Change Orders . . . . . . . . . . . . . . . . . . .$ « �S(9 � I(IaIC) • 01 Lo 9 a SUM TO DATE: . . . . . . . . . . . . . . . . . . . . . . .$ .� TOTAL COMPLETED & STORED TO DATE . . . . . .. . . . A,3.5 (Column G on G702A) TOTALS ^^ b0 RETAINAGE % . . . . . . . . . . . . . . . . .$ Net change by Change Orders $ r�1� or as noted in Column I on G702A TOTAL L•ARNM-&1-$S RETAINAGE . . .. .. . . . . . .. . .. . .$ h s;2-2 33r' Slate of: County of: rJ;I'- the unde(signed Contractor certifies that the Work coverer) by [his Appli• LE E I(l T:RTIFICATES FOR PAYMENT . . . .. . . .$ Cation for I'ayment has been completer) in accordance with the Contract Docurnenls, that all amounts have been paid by hint for Work for which eJM'G- f y payment issued and payments received from G�Px "SUE $ Ircviuus Certificates lot I'a ment were iss shown herein is now due. ` .e. .e r.' ' the Osaner, and that the current a m pC,P.�p�yo "S le3'Ahed and sworn o before me 0 /f day of CanlraClr)rr , i GO 01Ntttary Public: �� J. , a/ �!!"� / l ��'` r•^ My Commission eKpirNs: Date: In accordance_ with [lie C'o"nilract and this Application for I iymenl the Contractor is entitled to payment in the amount shown above. ❑ OWNER Architect: �1 ;� �/CRCHITECT ❑ CONTRACTOR ny: 1� ❑ This Certificate is nnl ne,r liable. If is ayable n sly to the paye-e named herein and its Issuance, payment . (I acceptance arc without prejudice to any rights of the Owner or Contractor under their Contract. AIA I)OCAINtINT G702V (\I'I'I 1(:AII( J AN (:I It l ll'ICAIf I()It PAYAIINT • MARCH 1'171 1'1)111()N • AIM) '•1 19)I . IIII AA11K1(:AN INS111U11: O !_Ii111. IS, 1715 NIW YORK AVE., N.W-,W,\SIIIN(:ION,I). C. 2001)4 R 1