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PPLICATION AND CERTIFICATE FOR PAYMENT AIA Document AM: City Of St. Anthony PROJECT: ST. ANTHONY COMITY CENTER APPLICATION NO: DISTRIBUTION TO: 3301 Silver Lake Rd. OWNER St. Anthony, MN 55418 PERIM TO; 09/30/96 —CON]MACTOR RON 1CONT): GRAUS CONSTRUCTION VIA (ARCHITECT)i Williams/O'Brien Assoc. ARCHITECT'S 360 HIGHWAY 61 N. OBJECT NO: HASTINGS, MN 55033 '�WRMT FORI General Construction CONTRACT DATE: 10/24/95 Application is made for Payment, as shown below, in connection 3 N T R A C T 0 RIS A P P L I C A T 1 0 N F 0 R P A Y M E N T with the contract. Continuation Sheet is attached. '"M ORDER SUMMARY 1 1. ORIGINAL CONTRACT SL44 ........................ 1 3151900.00 --1 2. Net Change by Change Orders .................. S 108471.00 iiange�Orders approved in I ADDITIONS I DEDUCTIONS 1 3. CONTRACT SUN TO DATE ..........................S 3,060371.N ,i.--evious months by owner . I 1 1 4. TOTAL COMPL.ETED & STORED TO DATE ............. 1 2089384.N TOTAL 1 108471.00 1 1 (Column 6 1 5. RETAINAGE: Approved this Month I I a. 5.08 % of Completed Work 1 1020559.20 I (Column D+E %umber IDate Approved I I I b. 5.00 % of Stored Material .4 1910.00 I I I I (Column F) I I I I Total Retainage (Line 5a+5b) or --I (Total in Column 1) ...................... 1 IM69.20 TOTALS 1 1 6. TOTAL EARNED.LESS RETAINAGE .................. S 1984914.80 -1 (Line 4 less Line 5 Total) at Change by Change Orders S 108471.09 1 7. LESS PREVIOUS CERTIFICATES FOR I PAYMENT (Line 6 from prior Certificate) .. 1 1641492.30 undersigned Contractor certifies that to the best of the Can- 8. CURRENT PAYMENT DUE .......................... 1 343422.50 ..ctorls knowledge, information, and belief the Work covered by 9. BALANCE TO FINISH, PLUS RETAINAGE .............1 1275456.20 -is Application for Payment has been completed in accordance with (Line 3 less Line 6) ..2 Contract Documents, that all amounts hAve been paid by the Can- ractor for Work for which previous Certificates for Payment were ssued and payments received from the Owner, and that current pay- ,ent shown herein is now due. PAM CBMIM—A BL1C-M!1NRE§OTA J JL WMA COUNTY - CMMfton Evims Jan.31,20 was ;0NTJ WR:.,6RPAJS OMTR410N State of. nv-m>r_c_jok County of: (:)aKp,4,Q Subscribed and 'A rn to before me this 25 day of lo 199(o Notary Public: (1y) - Eooc-"rm ;44 Date:/6-3—Z My Commission expires:-3�,,,, 51, AK)UNT CERTIFIED ............................... 134 ' RCHITECTIS C E R T I F I C A TE FOR PAYMENT (Attach explanation if amount certified differs from the amount applied for.) accordance with the Contract Documents, based on on-site observa- ARCHITET WillialIS/ VBrir Assoc. 'L�ions and the data comprising the above application, the Architect �rtifies to the Owner that to the best of the Architect's know- By- ___Pate._IAZL .,d formation, and belief the Work has progressed as indicated, s Certificate is not negotiable. The AMOUNT CERTIFIED is 70ty of the Work is in accordance with the Contract Documents,ryable only to the Contractor named herein. Issuance, pay- �n_ I -d the Contractor is entitled to payment of the AMOUK CERTIFIED. sent and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this contract.