Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
AIA� Document G742'� - 1992 <br /> Application and Certificate for Payment <br /> TO OWNER: City of Pequot Lakes PROJECT: Pequot Lakes Maintenance Garag APPLICATION NO: 1 Distributlon to: <br /> 4638 Main Street 4635 Derksen Road OWNER: <br /> Pequot Lakes,MN 56472 Pequote Lakes,MN 56472 PERIOO TO: 4/30/2018 ARCHITECT: <br /> FROM Boser Construction Inc. VIA CONTRACT FOR: General Construction CONTRACTOR: <br /> CONTRACTOR: 7135 5th Ave NE ARtHITECT: Widseth Smith Noltlng tONI'RACT OATE: FIELD: <br /> Sauk Rapids,MN 56379 7804 Industr(at Park Rd PROJECT NO: 8638 <br /> Baxter,MN 56425 <br /> CONTRACTOR�S APPUCATION FOR PAYMEM me�nde�s�ned conaaao�oerttne,tna�ro me�a n►e co�ractors�cnow�e,mtom►a�on and <br /> AppficaUon is made for payment,as shoMm below,in c�nneCtion wifh the CantraCt. beUef the Work covered by Ihts AppAcaeon tor Payment has been compleled tn e�ordance a�th the <br /> AIA DoCument G703TM,Contlnuaban Sheet.is atlaChed Conbaa Documents,mat eu emoums haue heen paid by the Contractar for Woric(or which prevlous <br /> 1.ORIGINAL CaNTRACT SUM $ 894,000.00 CeAtHcetes tor Peyment were issued end payments receired form ihe Oumer,and that cument <br /> .._.�._.... ...._ payment&hown hetein is rtow due. <br /> Z NET CHHIiWW(3ES IN THE WORK w ��� $ . <br /> 3.CONTRACT SUM TO DATE(lJNE 1+2) ��µ����µ��µ�"'mm""""" g gg4,000.Q0 CONTRACTOR: <br /> 4.TOTAL COMPLETED AND STORED TO DATE(CoG,mn G on G703) M_.�.�..��� $ 14,283.00 BY� Date:yi-Z+t-��, <br /> 5.RETAINAGE M������� State of�.,�, <br /> a 5%of Ccmplet�Work(Column D+E on G703J $ 714.15 County of:�,,.� <br /> b. �o of Stored Material(Column F on G703) _ � ��~�R/EYER <br /> $ Subscribed and sworn to before ��_� <br /> Total Retainage(Lines 5a+5b,orTotal in Column!on G703)��� �Wu `�T� $ 714.15 me this Z,`►� day o � ������ <br /> 8.TOTAL EARNED LESS RETAINAGE $ 13,568.85 Notary Pub�lic�: �Q� <br /> �Line 4 minus Line 5 Total) _'�`�.......�"�"""""__._...._W______�....»._� My Commis5�on es. �•Z� <br /> 7_LESS PREVIOUS CERTIFlCATE FOR PAYdIENT N��M��..µ��..���� $ - ARCHITEC7"S CERTIFICA PAYMENT <br /> (Llne 6 hom p►tor Certilkete) In accordance wfth tlre Conhect Doaimenls.based on on-site observadais�d the data compriaing <br /> 8.CURRENT PAYMENT DUE � 13.568.85 ���pn�on.the ArclUtect certlfies to the Oemer that ro the best ai tlre Archite�s krtonriedge, <br /> 9.BALANCE TO FIWISH,INCLUDING RETAINAGE��µM~M��_.�� �� tnfom�atlon e�d beuei the wonc has progressed as indh�ed,the quat�y of the work Is m accordance <br /> uYitn the contraa ooaimenta,ana the conaactor is e�med ro payment or the nMouWT <br /> (Line 3 minus Lbre B) $ 880,431,15 CERTIFlED. <br /> nAuourjr c�rm�eo.........................................._ a 13,568.85 <br /> (atlacn expl�anon�ernaimt o�aflea mrtera uom the amnunc appaea.�nlea�ap egures on ads <br /> CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Appit�lon and an the Condnuatlon Sheet tl�at are d�eng�to contorm with the amamt cerdfied.) <br /> Total d�anges approved in previous monGts by OHmer $ - $ - ARC <br /> Tatal approved this month $ - $ - 6y: ��� �� pace: 04/30/2018 <br /> TOTALS $ - $ - Thia certiAcete is not negd le.The AMOUNT CERTIFIED Is payebie�ly to the Contractor <br /> named hstetn.Is�ce,Paym�t mM ac;ceptance M payment are udthout preJudice to arty dghts oi tho <br /> NET CHANGES b Chan e Order a . �o�Contracror under 9�is Contract. <br /> AIA Documer►t G702"-199L Copyrisht m 1953,1963,1965,1971,1983 and 1992 by The Amerfcan Instftute of Architects.AII riQhta reserved.WARNING:THIS AIA°Oocument is protected by U.S.Copyright law and <br /> Internat�onal Treat�es.Unauthonzed reproduRfon of distribution of this AIA°Document,or any pordon of it,may result fn severe civll a�d cnminal penaltles,and will be prosecuted to the maximum extent possible <br /> undertheiaw <br />