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APPLICATION FOR PAYMENT NO. 3 Fina 1) <br /> To: City of St. Anthony, Minnesota (OWNER) <br /> From: Progressive Contractors Inc. (CONTRACTOR) <br /> . Contract: Ci.ty of St. Anthony <br /> Project: 33rd Avenue; Silver Lake Road to Highcrest Road; Concrete Pavement Rehab. <br /> OWNER's Contract No. -- ENGINEER's Project No. 10367.03 <br /> For Work accomplished through the date of: December 15, 1998 <br /> 1. Original Contract Pricer $ 322,332.90 <br /> 2. Net change by-Change Orders and Written Amendments(+or-): $ 11900.00 <br /> 3. Current Contract Price(1 plus 2): 5 324.232.90 <br /> 4. Total completed and stored to date: $ 341,130.13 <br /> 5. Retainage(per Agreement): <br /> --0_10 of completed Work: $ <br /> %of stored material: $ <br /> Total Retainage: $ 0.00 <br /> 6. Total completed and stored to date less retainage(4 minus 5): $ 341,130.13 <br /> 7. Less previous Application for Payments: $ -119,127-C)l <br /> 8. DUE THIS APPLICATION(6 MINUS 7): $ 22,002.22 <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 2 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 l I&- - i-7 - 9 Progressive Contractors, Inc. <br /> CO CTOR <br /> By: <br /> State of 0/1 r 14 11County of k) r ,4 <br /> Subscribed and sworn to before me this /-7 <br /> day of -'he c _ S ,� �, PArR1C1A A DZ►UK <br /> a NOTARYPUBLIC MINNESOTA <br /> � .� MY COMMISSION EXPIRES' <br /> Notary Public ' • JANUARY 31,2000 <br /> My Commission expires: /-3/-,Idag <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated December 15, 1998 Rieke Carroll 11 <br /> 01 <br /> . EJCDC No.1910-8-E (1996 Edition) By. <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 />