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APPLICATION FOR PAYMENT NO. Twenty-seven <br /> To City of St. Anthony (OWNER) <br /> Contract for Temporary Granular Activated Carbon System <br /> OWNER's Project No. . ENGINEER's Project No. 861908-3 • <br /> For Work accomplished through the date of August 31, 1990 <br /> CONTRACTOR's Schedule of values Work Completed <br /> ITEM Unit Price Quantity Amount Quantity Amount <br /> 1. Furnish & Install $ $ $ <br /> Treatment System 124,600.00 Lump Sum 124,600.00 100% 124,600.00 <br /> 2. Service Fee 108.00 500 Day 54,000.00 769 83,052.00 <br /> 3. VOC Removal 860.00 80 Pounds 68,000.00 76.69 lbs. 65,186.00 <br /> 4. Extra GAC 23.30 1600 c.f. 40,480.0 0 0.00 <br /> 5. Remove Equipment 38,650.00 Lump Sum 38,650.00 0 0.00 <br /> Total $325,730.00 (72,838.00 <br /> (Orig.Contract) <br /> C.O. No. 1 <br /> C.O. No.2 <br /> Accompanying Documentation: GROSS AMOUNT.DUE ....................... $ 272,838.00 <br /> LESS -7o RETAINAGE ................... $ Mone <br /> Invoice tip. 961097800 AMOUNT DUE TO DATE ..................... s272.838, 0 <br /> • <br /> LESS PREVIOUS PAYMENTS ................ $ 269.450.00 <br /> AMOUNT DUE THIS APPLICATION ......... $ 3.348.00 <br /> CONTRACTOR'S Certification: <br /> The undersigned CONTRACTOR certifies that (l) all previous progress payments received from OWNER on account of <br /> Work done under the Contract referred to above have been applied to discharge in full all obligations of CONTRACTOR <br /> incurred in connection with Work covered by prior Applications for Payment numbered 1 through inclusive;and <br /> (2) title to all materials and equipment incorporated in said Work or otherwise listed,in or covered by this Application for <br /> Payment will pass to OWNER at time of payment free and clear of all liens. claims. security interests and encumbrances <br /> (except such as covered by Bond acceptable to OWNER). <br /> Dated . 19 <br /> CONTRACTOR <br /> By <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated September 6, 1990_. 19 <br /> �4 • /EN i1NEER • <br /> BY - L <br /> EJCDC No. 1910-8-E(1983 Edition) -• <br /> Prepared by the Engineers'Joint Contract Documents Committee and endorsed by The Associated General Contractors of America. <br /> aspwed N) ii <br />