2018.06.18 CC Packet - Laserfiche WebLink

Home

AlA Document G702'" —1992 Application and Certificate for Payment TO OWNER: City of Hugo PROJECT: Hugo Fire Station 14669 Fitzgerald Avenue North 5323 140th Street North Hugo MN 65038 Hugo MN 55038 FROM CONTRACTOR: Diverse Construction ServicesVI&P&CHITECT- Roof Spec, Inc. Remit payments to: 2400 Prior Avenue North 82 - 38th Avenue NE St Paul MN 56113 Columbia Heights MN 55421-3502 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information Application is made forpayment, as shown below, in connection with the Contract. and belief the Work covered by this Application for payment has been completed in :accordance AIA Document 0703TM, 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 ................................................. S that current paymen • wn herein ispuw due. 2. NET CHANGE BY CHANGE ORDERS .............................. $ _______0750 CONTRACTOR 3. CONTRACT SUM TO DATE I Line 0 ( i�..................................... $ By: `��..r �'x3i �c. Date: 4. TOTAL COMPLETED & STORED TO DATE Column G au G703) ...... S State of. r ( 5. RETAINAGE: Colin of:d a. 5.00% ofCamplcled Will Sul ibc and wor obefore 8,009.35 3i� day of JIB{ i (C'nlumias D +Eat G7f1.1) S _ n . th b. .5.00 % of Stored Material (Cabman f on Gip?) $ 0.00 No blic: JENN SLM PLAN hty c rm iissi expires: NOTARYPIlIM-UNIrEiOTA Total Retainage (Litaes 5a + Sb, nr Tntol in Calnnvt L of G703J...... $_ 8,009.35 1131170 lewcolillismEll"W0113IXE) 6. TOTAL EARNED LESS RETAINAGE.................................... $ 162,177.65 A CHITECT'S CE TI ICATE FOR P (Line 9 minus Line 5 Twal) In accordance with the Contract Documents, based on on -site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ...................... S 63,620.26 this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, intlimation and belief the Work has progressed as indicated, the quality oP the Work is in (Line 6fi'omprior Ceriifrcaie) accordance with the Contact Documents, and the Contractor is entitled to payment of the S. CURRENT PAYMENT DUE ................. ��$-557.? AMOUNT CERTIFIED. ...........................• 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED.......................................................................... S 88,557.39 (Line 3 minus Line 6) $ 15,959.35 (Ahuch erplanntion if amount certified differs fiwin the anrount applied bliticrl (4lifigures on 1hir Application and on the Continuation Sheer ilia/ are changed to conform with the eanown cerlifced) HANGEORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: I oral changes approved in previous nhonths by Owner S _ $ By: Darr. 6/13/2018 Iola) approved this month $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTAL 1 S S named herein. Issuance, payment and acceptance ofpaynlent arc without prejudice to any rights of ET CHANGES by Chang, 0, or $ the Owner or Contractor under this Contract. CAUTION: You should sign an original AIA Contract Document, on which this text appears In RED. An original assures that changes will (lot be obscured. AIA Document G702- —1992. Copyright © 1953, 1963. 1965, 1971, 1976, 1963 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA•' Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA`- Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed, To report copyright violations of AIA Contract Documents, e-mail The American Institute of Archiects' legal counsel, copyright@aia.org. n APPLICATION NO: 2 Distribution to. PERIOD TO: 06/13/201 B OWNER Cl CONTRACT FOR: ARCHITECT ❑ CONTRACT DATE: CONTRACTOR ❑ PROJECT NOS: / / FIELD ❑