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APPLICATION FOR PAYMENT NO. 1 <br /> To: City of St. Anthony, Minnesota (OWNER) <br /> From: Standard Sidewalk,--Tn—c. (CONTRACTOR) <br /> Contract: City 0 t. n t on <br /> Project: Sidewalk Construction: St. AnthoFy -Blvd. and Kenzie Terrace <br /> OWNER's Contract No. '- ENGINEER's Project No, 10415.02 <br /> For Work accomplished through the date of: SPntPmhPr .15, 1998 <br /> 1. Original Contract.Price: S 147.088.75 <br /> 2. Net change by Change Orders and Written Amendments(+or-): S 0.00 <br /> 3. Current Contract Price(1 plus 2): S 147,088.75 <br /> 4. Total completed and stored to date: S 107,519.89 <br /> 5. Retainage(per Agreement): <br /> 5 %of completed Work: S 5,375-99 <br /> %of stored material: S <br /> Total Retainage: S 5,375.99 <br /> 6. Total completed and stored to date less retainage(4 minus 5): S 102.143.90 <br /> 7. Less previous Application for Payments: S n_nn <br /> 8. DUE THIS APPLICATION(6 MINUS 7): S 102,143.90 <br /> Accompanying Documentation: <br /> CONTRACTOR'S Certification: <br /> The undersigned CONTRACTOR certifies that(1)all previous progress payments received from OWNER on <br /> account of Work done under the Contract referred to above have been applied on account to discharge <br /> CONTRACTOR's legitimate obligations incurred in connection with Work covered by prior Applications for <br /> Payment numbered 1 through -- inclusive;(2)title of all-Work,materials and equipment incorporated in said <br /> Work or otherwise listed in or covered,by this Application for Payment will pass to OWNER at time of payment <br /> free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond acceptable to <br /> OWNER indemnifying OWNER against any such Lien,security interest or encumbrance);and(3)all Work covered <br /> by this Application for Payment is in accordance with the Contract Documents and not defective. <br /> Dated o -/,2 - 7 8, Standard Sidewalk, Inc. <br /> CONTRACTOR <br /> By: o-e�ti <br /> State of <br /> County of C�"a, <br /> Subscribed and sworn.t fore me this la*h j"'"""""'""" ONNIE S SCHMI"'�' <br /> day of t!��toh en c + � CONNIE.S.SCHMIDT <br /> Notary'PubGc-Minnesota t <br /> My Comm.Expires Jan.31,2000 <br /> Notary Public ....�....«.......- »... <br /> My Commission expires: 1'3l-Z <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated October 6. 1998 <br /> ER <br /> By. <br /> FJCDC No.1910-8-E (1996 Edition) <br /> Prepared by the Engineers Joint Contract Documents Committee and endorsed by The Associated General Contractors of America and the Construction Specification <br /> Institute. <br />