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APPLICATION FOR-PAYMENT NO. Seventeen <br /> To City of St Anthony (OWNER) <br /> Contract for Tpm orary rran11]Ar Activated Carbon System - . <br /> OWNER's Project No. --' ENGINEER's Project No. 861908-3 <br /> For Work accomplished through the date of October 31, 1989 <br /> CONTRACTOR's Schedule of Values Wort Completed <br /> ITEM Unit Price Quantity Amount Quantity Amount <br /> $ $ <br /> 1. Furnish & Install $ <br /> Treatment System 124,600.00 Lump Sum 124,600.00 100% 124,600.0 <br /> 2. Service Fee 108.00 500 Day 54,000.00 465 50,220.0 <br /> 3. VOC. Removal 850.00 80 Pounds 68,000.00 58.92 lbs 50;082.0 <br /> 4. Extra GAC 25.30 1600 cu/ft 40,480.00 0 0.0 <br /> 5. Remove Equipment 38,650.00 Lump Sum 38,650..00 0 0.0 <br /> Total $325,730.00 $224,902.0 <br /> (Orig. Contract) <br /> C.O. No. 1 <br /> C.O. No.2 <br /> Accompanying Documentation: GROSS AMOUNT DUE ....................... $224.902.00 <br /> LESS %RETAINAGE .. .............. $ None <br /> -Invoice No. 960847101 AMOUNT DUE TO DATE ....I................. $224.902.00 <br /> LESS PREVIOUS PAYMENTS ................ s221,554.00 <br /> AMOUNT DUE THIS APPLICATION ......... $--a.348.0 <br /> CONTRACTOR'S Certification: <br /> The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER on account of <br /> Work done under the Contract referred to above have been applied to discharge in full all obligations of CONTRACTOR <br /> incurred in connection with Work covered by prior Applications.for Payment numbered 1 through inclusive;and <br /> (2)title to all materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for <br /> Payment will pass to OWNER at time of payment free and clear of all liens, claims, security interests and encumbrances <br /> (except such as covered by Bond acceptable to OWNER). <br /> Dated • 19 CONTRACTOR <br /> By <br /> Payment of the above AMOUNT DUE THIS APPLICATION is reco nded. <br /> Dated October 31 , 19 A9 Rieke a of l Muller/Associates, Inc. <br /> - �EN GI R <br /> By <br /> EJCDC No. 1910-8-E(1983 Edition) <br /> Prepared by the Engineers'Joint Contract Documents Committee and endorsed by The Associated General Contractors of America. <br /> R.prereasns <br />