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APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TO OWNER CITY OF NEW BRIGHTON PROJECT: PUMP HOUSES 10&11 APPLICATION NO:FINAL/RETAINAGE Distribution to: 803 OLD HIGHWAY 8 OWNER NEW BRIGHTON MN 55112 ARCHITECT PERIOD TO: 2/29/2012 ( !CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: INSPEC I I Berwald Roofing Company,Inc. 2440 North Charles Street PROJECT NOS: North Saint Paul,MN 55109 CONTRACT FOR rooting and sheet metal CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment,as shown below,in connection with the Contract, information and belief the Work covered by this Application for Payment has been Continuation Sheet,AIA Document G703,is attached, completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for P • tea_ payments received from the Owner,and that current payment y.: •, I at dlean VanBlaricom Msm "` Notary Public 1. ORIGINAL CONTRACT SUM $ 79.400.00 - , ;, Minnesota 2. Net change by Change Orders S 0.00 CONTRACT R: -,. ,`•g*Cortm.:Aim E*esJaraa y31,2014 3. CONTRACT SUM TO DATE(Line I f 2) S 79.400.00 .. . 4. TOTAL COMPLETED&STORED TO S 79.400.00 �;,,�• I — DATE (Column G on G703) BY:./ i �/ _�_�. Date: 5. RETAINAGE: a. 0 %of Completed Work S 0.00 State of: MINNESOTA'A County of: WASHINGTON (Column D+E on G703) Subscribed and sworn to be/Core me his r day of f to (� b. %of Stored Material S Notary Public(. Jj cl Ct ) I 9 ` (Column F on G703) My Commission expires: 1/31/2014 Total Retainage(Lines 5a+5b or Total in Column lofG703) S 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE S 79.400.00 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) S 75,430.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE S 3.970.00 is entitled to payment of the AMOU CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE S 0.00 WM (Line 3 less Line 6) AMOUNT CERTIFIED 3,11.— CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Totai changes approved Application and onthe Continuation Sheet that are clanged to conform with the amount certified.) in previous months by Owner A HIT . Total approved this Month By. Date: p .( ( I s. TOTALS $0.00 $0.00 Cc ificate is not negotiable. The AMOUNT CERTIFIED is pa;able only to the Con or named herein.Issuance,payment and acceptance of payment arc without NET CHANGES by Change Order S0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702•APPUCATION AND CERTIFICATION FOR PAYMENT•1992 EDITION-AIA®-O 1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,NW,WASHINGTON,DC 200006292 User:may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee.