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APPLICATION FOR PAYMENT NO. 2 (Final) <br /> To. City of St. Anthony, Minnesota (OWNER) <br /> From: Jay Bros. , Inc. (CONTRACTOR) <br /> • Contract: UontraCt <br /> Project: Maintenance Work at the G.A.C. Water Filtration Plant <br /> OWNER's Contract No. ENGINEER's Project No. A-000010491.05 <br /> For Work accomplished through the date of: '9/15/99 <br /> 1. Original Contract Price: $- 1n,,456 n0 <br /> 2. Net change by Change Orders and Written Amendments(+or-): $ . 0 <br /> 3. Current Contract Price(1 plus 2): $ 10,456.00 <br /> 4. Total completed and stored to date: s10,012.98 <br /> 5. Retainage(per Agreement): <br /> 0 %of completed Work: $ 0 <br /> %of stored material: $ <br /> Total Retainage: $ 0 <br /> 6. Total completed and stored to date less retainage(4 minus 5): $ -10,012.98 <br /> 7. Less previous Application for Payments: $ 8,973.68 <br /> 8. DUE THIS APPLICATION(6 MINUS 7): $ 1,039.30 <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 1 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 - 9—.2,2 —2 Jay Bros. , Inc. <br /> CONTRACTOR <br /> By: 226 !5z� <br /> State of /Y)N, <br /> County of /2tlMSE`/ <br /> ..+�A+........�...o. <br /> Subscribed and sworn to before me this *:FRIONALD 4.ORFEI <br /> day of � — 2 Z `!`' <br /> Notary Public <br /> My Commission expires: /L3/ Le5— <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated September 20, 1999 SEH-RCM <br /> EJCDC 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 />