Laserfiche WebLink
APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AIA DOCUMENT G702) PAGE ONE OF 2 PAGES <br />TO (OWNER): City of New Brighton PROJECT: New Brighton Community Center APPLICATION NO: 8 <br />400 10th Street NW 400 10th Street NW <br />New Brighton, MN 55112 New Brighton, MN 55112 PERIOD TO: 18 -May -15 <br />FROM (CONTRACTOR): Rochon Corporation VIA (ARCHITECT): Rosa Architectural Group <br />3650 Annapolis Lane N, Ste 101 1084 Sterling Street <br />Plymouth, MN 55447 St. Paul, MN 55119 <br />ARCHITECT'S <br />PROJECT NO: 18039 <br />CONTRACT FOR: General Construction CONTRACT DATE: 8/27/2014 <br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection <br />CHANGE ORDER SUMMARY with the Contract, Continuation Sheet, Substitute AIA Document <br />DEDUCTIONS G703 Is attached. <br />Change Orders approved in ADDITIONS <br />The undersigned Contractor certifies that to the best of the Contractor's <br />knowledge, information and belief the Work covered by this Application <br />for Payment has been completed in accordance with the Contract <br />Documents, that all amounts have been paid by the Contractor for Work for <br />which previous Certificates for Payment were issued and payments received <br />from the Owner, and that current payment shown herein is now due. <br />By: <br />Rochon Corporation <br />Date: May 18, 2015 <br />1. ORIGINAL CONTRACT SUM .................................... $ 682,000.00 <br />2. Net Change by Change Orders ................................. $ 24,800.08 <br />3. CONTRACT SUM TO DATE (Line 1+/-2). .... ........... $ 706,800.08 <br />4. TOTAL COMPLETED & STORED TO DATE.__,...... $ 706,800,08 <br />(Column G on G703) <br />5. RETAINAGE: <br />a._% of Completed Work <br />(Column D+E on G703) <br />b.—% of Stored Material <br />(Column F on G703) <br />previous months by Owner <br />1-5 TOTAL <br />24,800.08 <br />Approved this Month <br />Number Date Approved <br />Total in Column I of G703) ................................. <br />$ <br />0.00 <br />TOTALS <br />0.00 <br />1 0.00 <br />Net change by Change Orders 24,800.08 <br />The undersigned Contractor certifies that to the best of the Contractor's <br />knowledge, information and belief the Work covered by this Application <br />for Payment has been completed in accordance with the Contract <br />Documents, that all amounts have been paid by the Contractor for Work for <br />which previous Certificates for Payment were issued and payments received <br />from the Owner, and that current payment shown herein is now due. <br />By: <br />Rochon Corporation <br />Date: May 18, 2015 <br />1. ORIGINAL CONTRACT SUM .................................... $ 682,000.00 <br />2. Net Change by Change Orders ................................. $ 24,800.08 <br />3. CONTRACT SUM TO DATE (Line 1+/-2). .... ........... $ 706,800.08 <br />4. TOTAL COMPLETED & STORED TO DATE.__,...... $ 706,800,08 <br />(Column G on G703) <br />5. RETAINAGE: <br />a._% of Completed Work <br />(Column D+E on G703) <br />b.—% of Stored Material <br />(Column F on G703) <br />Total Retainage (Line 5a+5b or <br />Total in Column I of G703) ................................. <br />$ <br />0.00 <br />6. TOTAL EARNED LESS RETAINAGE ....................... <br />$ <br />706,800.08 <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate).......... <br />$ <br />671,460.08 <br />8. CURRENT PAYMENT DUE ....................................... <br />$ <br />35,340.00 <br />9. BALANCE TO FINISH, PLUS RETAINAGE .............. <br />$ <br />0.00 <br />(Line 3 less Line 6) <br />State of: Minnesota County of: Hennepin <br />Subscribed and sworn to ore me this 18th day of May, 2015 <br />O,VEMy <br />PATRlCIA JEANE WOTZKA <br />Notary Public -Minnesota Notary Public: <br />Commission Expires Jan 31, 2020 <br />lvv-evvvvvvvvv%AFVVVVVVVVN^tvv%v~ <br />My Commission expires: January 31, 2020 <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on on-site observations <br />and the data comprising the above application, the Architect certifies to the <br />Owner that to the best of the Architect's knowledge, information and belief the <br />Work has progressed as indicated, the quality of the Work is in accordance <br />with the Contract Documents, and the Contractor is entitled to payment <br />of the AMOUNT CERTIFIED. <br />AMOUNT CERTIFIED .................................$ <br />(Attach explanation if amount certified differs from the amount applied for.) <br />ARCHITECT: <br />By: Uate: <br />This certificate is not negotiable. The AMOUNT CERTIFIED is payable <br />only to the Contractor named herein. Issuance, payment and acceptance <br />of payment are without prejudice to any rights of the Owner or Contractor <br />under this Contract. <br />