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G,S ° AIX Document G702"m —1992 Application and Certificate for Payment TO OWNER: "lly Y1 ^'la° PROJECT: 14669 Fitzgerald Avenue North Hugo FireStation 6323140th Street North APPLICATION NO: 1 Distribution to: Hugo MN 55038 Hugo MN 66038 PERIOD TO: OS/25/2018 OWNER ❑ CONTRACT FOR: ARCHITECT ❑ FROM CONTRACTOR: Diverse Construction ServiceWAAACHITECT: ROWSpec, inc. Remit payments to: 2400 Prior Avenue North CONTRACT DATE: CONTRACTOR ❑ 82 - 38th Avenue NE St Paul MN 55113 PROJECT NOS: / / FIELD ❑ Columbia Heights MN 55421-3502 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infomlation Application is made for payment, asshown'below, in connection will, the Counacl. and belief the Work covered by this Application for Payment has been completed in accordance AIA Document 0703Tar, Continuation Sheet, is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 168,137.00 which previous Certificates for Payment were issued and payments received from the Owner, and 1.ORIGINAL CONTRACT SUM ................................................ $ $D0 that current payment shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS .............................. $ CDNTRAC 3. CONTRACT SUM TO DATE (Line l t 2)................................ $ Qe 1 000 By- Date: Q 48 4. TOTAL COMPLETED S STORED TO DATE (Cohrmn C on G70/) ...... $ State 5. RETAI"qE: County of:)Y-pje,_ a. % of Completed Work 3,348.44 4o- d and sworn t etbre �n (Gy.6pnns D + E ort 6703) $ 2G"�day of r b• _%ofStoredMaterial 0.00 "Mum", (Cohaun F on G703) $ i c.ri-) NOWKI M-NSA3,348,44i expires: //a �, E 00bW Total Retainage (Circe Sn + sb. or Total in Cohunn 1 of G703)...... $ 6. TOTAL EARNED LESS RETAINAGE.................................... $ 6 CHITECT'S CERTIFICATE FOR PAYMENT (Lire 4 minas Line 5 Total) 0.00 In accordance with the Contract Documents, based on on -site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ...................... this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, $ information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6frorn prior Certificate) accordance with the Contract Documents, and the Contractor is ent the 63,6201? ............... 6. CURRENT PAYMENT DUE ................... ......... $ AMOUNT CERTIFIED. . 9. BALANCE TO FINISH, INCLUDING RETAINAGE 104,516.74 AMOUNT CERTIFIED .................................................... 63,620.26 (Line 3 minus Line 6) $ (Arroch eaplariation ffamomrt ceriified differs from the amount t ' Application and on the Continuation Sheer /ba( are changed to conform with the amount certifier..) HANGE ORDER SUMMARY ADDITIONS I DEDUCTIONS I ARCHITECT: �7 Total changes approved in previous months by Owner $ $ By. Dare: 5-29-2018 Total approved this month $ Is This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTAL Js named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of ET CHANGES b a Chan a Order $ the Owner or Contractor under this Contract CAUTION: You uhould slgr an original AIA Contract Document. On witch this teat appears In REO An original assures that caanges will not be obscurest. AIA Document G702- - 1992, Copyright 01953, 1963, 1965. 1971. 1973, 1983 and 1992 by The American Institule of Architects. All rights reserved. WARNW6; This AIA° Doounrnf is proaAeied by U.9 Copyright Law and tntematonel Tmates. Umuthonzed reproduction of distribu6nn of this AIA. Document. Or any portion of It may result In severe chill and crkninal penallfes. and will be proseelead to the mattinum extent possible uruler the taw. Purchasers are permitted to reproduce ten (10) copies or this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@ais.org.