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APPLICATION FOR PAYMENT NO. 3 <br /> To: Ci ty of. St. Anthony, Minnesota (OWNER) <br /> From: Forest Lake Contracting. Inc. (CONTRACTOR) <br /> Contract: City of St. Anthony <br /> Project: 1998 Watermain Street' and'Storm Sewer Improvements <br /> OWNER's Contract No. -- ENGINEER's Project No. 10408.03 <br /> For Work accomplished through the date of 7/25/98 . <br /> 1. Original Contract Price: s 533,674.45 <br /> 2. Net change by Change Orders and Written Amendments(+or-): $ 0.00 <br /> 3. Current Contract Price(1 plus 2): S 533.674.45 <br /> 4. 'focal completed and stored to date: S . 566,638.44 <br /> 5. Retainage(per Agreement): <br /> __5210 of completed Work: S ?Ft.331 _92 <br /> %of stored material: S <br /> Total Retainage: $ 28,331.92 <br /> 6. Total completed and stored to date less retainage(4 minus 5): S 538„306.5? <br /> . 7. - Less previous Application for.Payments: S 488.775.61 <br /> 8. DUE THIS APPLICATION(6 MINUS 7): S 49-530_q1 <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 Forest Lake Contracting, Inc. <br /> CONTRACTOR <br /> By- <br /> State of <br /> County of <br /> Subscribed and sworn to before me this <br /> day of , <br /> Notary Public <br /> My Commission expires: <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated July 30. 1998 <br /> G <br /> By: <br /> EJCDC No.1910-8-E (1996 Edition) Construction Services Engineer <br /> Prepared by the Engineers Joint Contract Documents Committee and endorsed by 7be Associated General Contractors of America and the Construction Specification <br /> Institute <br />