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! PR CATION AND CERTIFICATE FOR PAYMENT AIA Document City Of St. Anthony PROJECT: ST. ANTHONY COPMLR(ITY CENTER APPLICATION NO: 3 DISTRIBUTION TO: 3301 Silver Lake Rd. OWNER St. Anthony, MN 55418 PERIOD TO: MARCH 31, 1996 ARCHITECT }CONTRACTOR 'ROM (CONT): GRAUS CONSTRUCTION VIA (ARCHITECT): Williams/O'Brien Assoc: ARCHITECT'S R.O. BOX 34 PROJECT NO: _ HASTINGS, MN 55033 ANTRACT FOR: General Construction CONTRACT DATE: 10/24/95 Application is made for Payment, as shown below, in connection ; 0NTRACT0R'S APPLICATION FOR PAYMENT with the contract. Continuation Sheet is attached. ------:_ -------------------------------I CHANGE ORDER SUMMARY 11. ORIGINAL CONTRACT SUM ........................ f 3151900.00 -----------=-----------------------------------------I 2. Net Change by Change Orders .................. $ .00 Change Orders approved in I ADDITIONS I DEDUCTIONS 1 3. CONTRACT SUM TO DATE ...........................5 3151900.00 previous months by owner I 1 1 4. TOTAL COMPLETED d STORED TO DATE ............. S 260400.00 TOTAL I I 1 (Column G ) ------------------------------------------------------------1 5. RETAINAGE: Approved this Month I I I a. 5.00 % of Completed Work f 8005.02 -------------------------1 I I (Column D+E ) Number IDate Approved I I I b. 5.00 % of Stored Material S 5015.00 I I 1 I (Column F) I I I I Total Retainage (Line 5a+5b) or ---W-----------------=---------------------------- I (Total in Column I) f 13020.00 � TOTALS I 1 1 6. TOTAL EARNED LESS RETAINAGE .................. S 247380.00 ------- -- -------- —I (Line 4 less Line 5 Total) Het Change by Change Orders S .00 1 7. LESS PREVIOUS CERTIFICATES FOR ----------------------------------------------------------------I PAYMENT (Line 6 from prior Certificate) .. f 96140.00 he undersigned Contractor certifies that to the best of the Con- B. CURRENT PAYMENT DUE .......................... S 151240.00 °actor's knowledge, information, and belief the Work covered by 9. BALANCE TO FINISH, PLUS RETAINAGE .............S 2904520.00 ;:is Application for Payment has been completed in accordance with (Line 3 less Line 6) he Contract Documents, that all amounts have been paid by the Con- ractor for Work for which previous Certificates.for Payment were �a�t �Qficff ssuEd and payments received from the Owner, and that current pay- F&M N pTARYpUmIK MINNESOTA ent shown herein is now due. --- �pMM1510N EXPIRES T JANUARY 31,Z� -- .7NTRACTOR:GRAUS CONSTRU TION State of: �/�,ihh�}(� County of Subscribed and Sworn to before i_s °,41ay of w 1,19ko ,/ /_p/ Notary Public w, AA /: - Date: / /(� My Commission expires: ��,3� �U U ------------ ----- ----------- - -------------------------------------------------------- ---- --------------------------- AMOUNT CERTIFIED ............................... S 1�;(j 240 X I R C H I T E C T'S C E R T I F C ATE F O R P A Y M E N T (Attach explanation if amount certified differs from the amount applied for.) n accordance with the Contract Documents, based an on-site observa- ARCHITE : Williams ' rien asoc. tions and the data comprising the above application, the Architect ert' to the Owner that to the best of the Architect's know- By: Date: edglWformation, and belief the Work has progressed as indicated, s tirtificate is not negotiable. The AMOUNT CERTIFIED is he quality of the Work is in accordance with the Contract Documents,- yable only to the Contractor named herein. Issuance, pay- ,nd the Contractor is entitled to payment of the AMOUNT CERTIFIED. went and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this contract.