CCP 07-09-2013 - Laserfiche WebLink

Home Browse Search

APPLICATION AND CERTIFICATE FOR PAYMENT TO OWNER: NEW BRIGHTON PROJECT: APPLICATION NO: I Distribntlnnto: 803 OLD HIGHWAY 8 NW TOWER REPAIR AND RECONDITIONING PERIOD TO: 6/15/2013 _OWNER NEW BRIGHTON,MN 55112 CITY OF NEW BRIGHTON PROJECT NO(s): X ENGINEER CONTRACTOR FROM CONTRACTOR: CHAMPION COATINGS CONTRACT DATE: 9/14/20I2 _ 7385 WEST I26th STREET SAVAGE,MN 55378 VIA ENGINEER: PURCHASE ORDER N BOLTON&MENK CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information end belief the Work Application is made for payment,as shown below,in connection with the covered by this Application for Payment has been completed in accordance with the Contract Documents,that all Contract Continuation Sheet. amounts have been paid by the Contractor fbr Work for which previous Certificates for payment shown herein is now due 1. ORIGINAL CONTRACT SUM. S 278,000 CONTRACTOR: 2. Net change by Change Orders... ... .. ........... S 0 {��, By' --w . —.,Y Date: 6/17/2013 3. CONTRACT SUM TO DATE(Line I+2)_ _ ,., , S 278,000 Robert Cox State of Minnesota 4.TOTAL COMPLETED&STORED TO DATE, -... S 185,300 County of. Scott Subscribed end sworn to before me this 17th day of June,2013 , 5 RETAINAGE• • 4-.4 ` SHERRI MOWN, 1 a 5%of Completed Work S 9,265 Notary Pul 7l'� Q)- L x:i 1—� t NOTARY PUBLIC-MINNESOTA ' (ColumnD+E) '1 � My Commission Expires Jan.31,2016 lti b. _%of Stored Material S ., My Commission copses Li.L"'l. 3'I c:11 J}�(J - llllsri.„.„.„,7,', (Column F) ENGINEER'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE.. . .. - S 176,035 (Line 4 less Line 5 Total) In accordance with the Contact Documents,based on on-site observations and the date comprising this application, the Architect certifies to the Owner that to the best of the Architect's knowledge,information and belief the Work has 7 LESS PREVIOUS CERTIFICATES FOR PAYMENT progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and the Contractor (Line 6 from prior Certificate) S 0 Is entitled to payment of the AMOUNT CERTIFIED S. CURRENT PAYMENT DUE. . ..............................._ S 176,035 AMOUNT CERTIFIED. S 1 q 4.103g-00 (Attach explanation If amount certified dlersfrrmr the amount applied for initial all figures on this 9. BALANCE TO FINISH,INCLUDING RUMMAGE Application and an the Continuation Sheet that are c/srmged to conform to the amount certified. (Line 3 reunite 6) S 101,46.5 L��/� /::24T,/47:: ) nADDITLONS DEDUCTIONS tq a!J4,4 l o3 Date: previous months by Owner Total approved this Month This Certificate is not negoleble- The AMOUNT CERTIFIED is payable only to the Contractor named herein TOTAL. Issuance,payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor IYET CHANGES by Change Ordr under this Contract