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PPLICATION AND CERTIFICATE FOR PAYMENT AIA Document ;i (OWNER).- City Of St. Anthony PROJECT: 5T. ANTHONY COMMUNITY CENTER APPLICATION NO: 14 DISTRIBUTION TO: • 3301 Silver Lake Rd. OWNER St. Anthony, MN 55418 PERIOD TO: 08/01/97 ARCHITECT _CONTRACTOR 'ROM (CONTI: GRAUS C014STRUCTION VIA (ARCHITECT): Williams/O'Brien Assoc. ARCHITECT'S 360 HIGHWAY 61 N. PROJECT NO: _ HASTINGS, MN 55033 MTRACT FOR: General Construction CONTRACT DATE: 1 0/24/95 Application is made for Payment, as shown below, in connection : 0NTRACT0R'S APPLICATION FOR PAYMENT with the contract. Continuation Sheet is attached. ---------------------—----—---—---------------------------I .11ANGE ORDER SUMMARY 1 1. ORIGINAL CONTRACT SUM ........................ f 3151900.00 -----------------------------------------------------1 2. Net Change by Change Orders ... f awi- 0 dtw ;hange Orders approved in I ADDITIONS 1 DEDUCTIO145 1 3. CONTRACT SUM TO DATE ....... .1-A:CZ...I 428292-7.@@ 6W )revious months by owner I 1 1 4. TOTAL COMPLETED d STORED TO DATE {�:'y�.r.,:�'. f &%69.1.37.@Odi.W TOTAL 1 13107.00 1 1 (Column G ) .---------------------—------------------ ----------------1 5. RETAINAGE: `approved this Month I I I a. 5.00 % of Completed Work f .00 ----------------------------I I I (Column D+E ) ;Number IDate Approved I I I b. 5.00 % of Stored Material f .00 I I I I (Column F) I I I I Total Retainage (Line 5a+5b) or 2/c 6542o•oo LM �------------- TOTALS I I -- ---- 16. TOTALTEAaRNEDnLES5umRETAINAGE...3�l�iI�58o,iID.,'f .00 , ----------------------- S 32664-3:00 -----------------------------------------------------------I (Line 4 less Line 5 Total) Net Change by Change Orders f 131027.00 1 7.'LESS PREVIOUS CERTIFICATES FOR !----------------------------------------------------------------I PAYMENT (Line 6 from prior Certificate) ., f '3',054,427.05 61t 'le undersigned Contractor certifies that to the best of the Con- B. CURRENT PAYMENT DUE ...........�.1-Zt1� ;45, f s� '"actor's knowledge, information, and belief the Work covered by 9. BALANCE TO FINISH, PLUS RETAINAGE f -16014.-00- (q.p !is Application for Payment has been completed in accordance with (Line 3 less Line 6) a Contract Documents, that all amounts have been paid by the Con- -�ctor for Work for which previous Certificates for Payment were sued and payments received from the Owner, and that current pay- e••••.r .�{at1 A. Cagdt art shown herein is now due. ------------ A1OA - 11d1°��- -------------- o� MY COMMISSION EXPIRES •...� JANUARY 31,2000 ..IITRACTOR:GRAUS C014STRUCTIDI State of: Minnesota County of I3kota Subscribed and Sworn to beffor-e, me thisl of Aug. 19-97 Notary Pub1i� CA�� V� Date: 8-137 My Commission expi s: 1/31/2000 ---------- AMOUNT CERTIFIED ............................... f �15Z.15- 1 R C H I T E C T'S C E R T I F I C A E F 0 R P A Y M E N T (Attach explanation if amount certified differs from the amount ap lied for.) '.n accordance with the Contract Documents, based on on-site observa- ARCHITE W' 'ams/0 r'en oc. ;ions and the data comprising the above application, the Architect ,rtifies to the Owner that to the best of the Architect's know- By: Date � q J -dge, information, and belief the Work has-progressed as indicated, h's Certificate is not ne o iable. The AMOUNT CER I E s • quality of the Work is in accordance with the Contract Documents gable only to the Contractor named herein. Issuance, pay-- 1 the Contractor is entitled to payment of the AMOUNT CERTIFIED. vent and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this contract.