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Af'ti___ATION AND CERTIFICATE FOR PAY_* .T AIA DOCUMENT G702 PAda_.c OF PAGE <br /> PROJECT: St. Anthony Liquor Addition ARCHITECT: B W B R Architects <br /> (name, address) p <br /> ARCHITECT'S PROJECT NO: 51033 <br /> TO (Owner) City of St. Anthony CONTRACTOR: l-,ullerton Lwnber Cc. tl?:, /�S1 <br /> CONTRACT FOR: L ' E U i t S +D r•C <br /> APPLICATION DATE: g�/o1 1�$ APPLICATION NO: a <br /> ATTN: PERIOD FROM: TS J I ' °� TO <br /> CHANGE ORDER SUMMARY Application is made for Payment, as shown below, in connection with the Contract. <br /> Continuation Sheel,AIA Document G702A, is attached. <br /> Change Orders approved ADDITIONS E DEDUCTIONS $ <br /> in previous months by The present status of the account for this Contract is as follows: <br /> Owner— <br /> TOTAL ORIGINAL CONTRACT SUM . ... . . . . . . ... . . . . ..$ 288,500.00 <br /> Suhscrlucni ChangcOrdeis <br /> 1lumhr:r Approvccl Net change by Change Orders '' ' . . . . . . . . . . . . . . . .$ <br /> Idalcl <br /> CONTRACT SUM TO DATE . . . . ... . . . . . . . . . . . . . . . .$ S 2, JUG <br /> TOTAL COMPLETED & STORED TO DATE . .. . . . . .. .$ <br /> (Column G on G702A) <br /> TOTALS RETAINAGE _5 "/° . . . .. . . . . . . . . . . . . . . . .. . . .$- <br /> Net change by Change Orders $ or as noted in Column I On G702A <br /> TOTAL EARNED LESS RETAINAGE . . .. . . . . . . . . . . . . . .$ ~ <br /> 7 <br /> Stale oL• County of: <br /> 1he undersigned Contractor certifies Ihat the Work covered by this Appli- LESS PREVIOUS CF:RTIFIC-A' FOR PAYMENT . .. . . . . .$ LI 5 • J S 2 <br /> cation for Payment has been completed in accordance wish the Contract ����g tr <br /> j Documents, that all amounts have been paid by him for Work for which P �,O _ O <br /> previous Certificates for Payment were issued and a �.j^ v��,�, --a..J;, ,• . . . . . . . . . .. . .$ —� 2 9 76 <br /> p payments received from CURRENT P � � l <br /> the Owner, and that the current payment shown herein Is now due. <br /> pO v�av G 9Ma,yc <br /> Contractor:) Su r rc(G��rii�g LO This a 2` day of �u� : 19�7 <br /> Wrr AC: <br /> ny: Dale: <br /> g , <br /> In accordance with the ntrac this App i ion for Payment the Contractor is emit d ayment in the amount shown above. ❑ OWNER <br /> Architect: ❑ ARCHITECT <br /> s � ❑❑ CONTRACTOR <br /> This Cerlilicaic is not n gnuafhle. It is paya rte only to the payee named herein and its issuance, payment and acceptance arc wiit i reiudice to any rights of the Owner of Cnnlraclur <br />under (heir Contra <br /> AIA DOCUMI.NT r 702 • AI1111CATiON AND Cf.R rll'1(:Af1 I OR PAYMI NT • 10ARCI l 11171 I.I)I I ION • AIAO <br /> ^) 1'171 • IIIt AASrRICAN INS1IllJ1F Or ARCHI11.CIS. 1735 NI.W YORK AVL.N.W.,WASIIIN(;I'ON,1). C.20006 <br />