09.01A Maintenance Facility Project - Boser Construction Payment Certificate #3

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AIA� Document G702� - 1992 Application and Certi�icate for Payment TO OWNER: City of Pequot Lakes PROJECT: Pequot Lakes Mafntenance 6arag• APPLICATION NO: 3 Distribution to: 4638 Main Street 4635 Derksen Road OWNER: Pequot lakes,MN 56472 Pequote Lakes,MN 56472 PERIOD TO: 6/30/2018 ARCHITECT: FROM Boser Consuuttion Inc. VIA CONTRACT FOR: Generel Construction CONTRACTOR: CONTRACTOR: 7135 Sth Ave NE ARCHITECT: Wtdseth Smith Nolting CONTRACT DATE: FIELD: Sauk Rapids,MN 56379 7804 Industrial Park Rd PROJECT NO: 8638 Baxter,MN 56425 CONTRACTOR'S APPLICATION FOR PAYMEM The underslgned Contrac�or certlAes that to the best ot the Ccntractor's WroxAedge,infom�adon and Appfit�tion is made for paymeM,as shown betow,in connection with the Conhact. ��0►��e�d�'�MpAptl°n tor Pay"'e"t has bee"completed in acao►dence wffh the AIA Document G703TM,Contlnuation Sheet,is attached. Contrect Dowments.that all mnol►nb heve b8en peld by dte Conhattot tor Work for which prevlou3 1.ORIGINAL COMRACT SUM � �.�.� �emficates for Payment�rere issued and paymeMs received tam ths Owner,and tha!ament .�....._....w.._._.__.___..._......__.....�..�...�.._.....__.._... payment shawn heroln is now due. 2.NET CHANOES IN THE WORK $ - /C� ._..._.......__...._.............._M..._......�._................_._.........._. 3.CONTRACT SUM TO DATE(UNE 1+2) $ 894,000.00 CONTRACTOR: 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703) ��M��w� � $ 231,424.00 By: Date: �o•o�.�./8 5.RETAINAGE ��w�� State of:� a. 5%o�Ccmpteted Work(Column 0+F�G703) $ 11,571.20 County of��-, �c� ��M� '�k1tpR b. Oo�°i St°red Material(Column F on G703) g _ Subscribed and sworn to befor r�; � ., �1►'ubik- Total Retainage(Lines 5a+56,o�Total in Column J on G703) $ 17,571.20 me this �� a� �� Ji►.3],�p _..�......._......_.._..__.._.........._._......_. - 8.TOTAL EARNED LESS RETAINAGE $ 219,852.80 Notary Publi � ....._.__....____....w..........._.__.._........W...._.._.._....._. Y . (Urte 4 minus Lfne 5 Totel� M Commi on es• 7..LESS PREVIOUS CERT(FICATE FOR PAYMENT $ 75,674.15 ARCHITECTS CERTIFICAT 0 AYMENT _..._..__.._............__...._........._.._............ (Une 6 from prior CertHlcateJ In accordance with ihe Contract Dacuments.baaed on on-stte observatlona artd the deia comprising 8.CURRENT PAYMENT DUE $ 144,178.65 ��p�0".�ei��°��ro fhe Oarner Ihai to the best oi the Architects knowledge, _____.._._._..._..___.�_.....__..___._._.__......�_�...__w___..__ mrormanon ana aener�e work nas proyre.ssea as mdlceted,me quaary of we wonc Is m accora�ce 9.BALANCE TO FlNISH,INCLUDINO ItETAINAGE y�i�h pre Contract pocumenb,and the CflnUactor is en�ed ro payment W the AMOUNT (Une 3 m(nus L.fne 6) $ 874,147.20 CERTIFlED. AMOUAfT CERTIFIED............................................ 8 - $144,178.65 (Atmch exptanatlon H amount certlHed dHfers han fhe anmwrt epplied.Irn8a1 all ftgures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Appucaeon and an the CandnuaUon SAeet that are changed to confarm uuim fhe amaunt certiAed.} Total changes approved in previous manths by Owner $ - a - ARGHI� �n� Totat approved this month $ - $ - By: .,....� (.E� �_ Daro: 6/22/2018 70TALS $ - a - fiis catlAcate ia rrot negoUabte.The AMOUNT CERTIFIED ts payabla only to the ConUactor narrted hereln.Isauartoe�PaYme�and aa:eptance of payment are wflhout prejudice to any dghfs of the NET CHANGES b Ch e Order $ _ Owner or Contracror u�er this Comred. AIA Dotument G702"'-199L Copyright�1953,19b3,1465,1971,1983 and 1992 by The Amerlan Instftute of Archftects.All rlahts reserved.WARNING:THIS AIA°Document is protected by U.S.Copyrlght Law and In[emational Treaties.Unauthorized reproduction of distribution of this AIA°Dotument,or any portion of It,may result in severe civil and crfminal penalties,and will be prosecuted to the maximum extent possfble underthelaw.