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.. .0 . ��v +v.. . v.. ......-... Zvi. . ......... <br /> total Contract Amount $- 4.96 ,659.48 Total Amount Earned $ 4791,863.88 <br /> Material Suitably Stored on Site, Not Incoporated into Work $ <br /> C•ract Change Order No. 1 Percent-Complete 100% $ 1x680.00 <br /> Contract Change Order No. 2 Percent Complete 100% $ 19277.00 <br /> Contract Change Order No 3 Percent Complete 100/ $ 5.546.10 % <br /> GROSS AMOUNT DUE. . . . . . . . . . . . . . . $ 488_36(,_98 <br /> LESS % RETAINAGE. . . .-. .. . . $ —� <br /> AMOUNT DUE TO- DATE. . . . . . . . . . . . . $ 488.366.98 <br /> LESS PREVIOUS APPLICATIONS. . . . . $ 4819973.90 <br /> AMOUNT DUE THIS APPLICATION. . . . $ 6.393.08 <br /> CONTRACTOR'S AFFIDAVIT <br /> The undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress. <br /> payments received from the Owner on account of work performed under the contract referred to <br /> above have been applied by the undersigned to discharge in full all obligations of the under- <br /> signed incurred in connection with work covered by prior Applications for Payment under said <br /> contract, and (2) all <br />:material and equipment incorporated in said Project or otherwise listed in or covered. by this <br />:Application for Payment are free and clear of all liens, claims, security interests and <br /> encumbrances. <br /> Da* 19 Matheny Construction <br /> �— Contractor <br /> By <br /> (Name and itle) <br /> COUNTY OF Zb2 Y ) SS <br /> STATE OF <br /> 3efore me on this �4n1 day of 19 93 personally appeared <br /> known to me, who being duly sworn, did depose <br /> and say that he is the of the Contractor above mentioned; <br /> Office <br /> that he executed the above Application for Payment and Affidavit on behalf of said Contractor; <br /> end that all of the ,. rein are tru correct and complete. <br /> ANNE B. BOLOGNA <br />-1y Commi ss14n Expi r NOTARY PUBLIC-MINNESOTA <br /> RAMSEY COUNTY Notar ubl is <br /> My Commission Expires July 24, 1986 <br /> she undersigned has c ecced a on rac or sYApplication for Payment shown above. A part of <br />:his Application is the Contractor's Affidavit stating. that all previous payments .to -him <br /> ender this Contract have been applied by him to discharge in full all of his obl-igations .in <br />:onnection with the work covered by all prior Applications for Payment.. <br />-n accordance with. the Contract, the undersigned approves payment to th_e Contractor of -the <br /> Imoe Due. <br /> SHORT- TT 0 <br /> gate v/ / /9.b'3 .. By <br />'age Z 5 of 5 <br />