09.01B Maintenance Facility Project - Greystone Construction Payment Certificate #1

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APPLICATION AND CERTI�ICATION FOR PAYMENT AIADOCUMEIVTG702 PAGEONEOF 2 PAGES TO OWNER: PROJECT: APPLICATION NO 1 Distnbution to: City of Pequot Lakes Pequot Lakes Main� APP.DAT'E 06/28/18 X OWNER 4638 Main Street Depardnent Ga►age ��.E�. Pequot Lakes,MN 56472 Project#0130B0063.000 PERIOD TO: 06/30/18 �CONTRACTOR FROM CONTRACTOR: VIA,�RCgITECT; � Greystone Constructlon Compmry Architect Name � S00 S.Marschall Road,Suite#300 Architect Address PROJEG"T NOS: FS 18-8170 Shakopee,MN 55379 Architect Address CONTRACT FOR: CONTRACT DATE 03/Ol/18 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contxactor's Imowledge, Applicatioa is made for payment,as shown below,in connection with the ConRact. informetion and belief the Work covered by this Application for Payment has beaa Continuation Shcet,AIA Documtat G703,is attached. completed in accordance with the Contract Doc�mts,fl�at all amoimts have been paid by the Contractor for Work for w1ucL pravious Certificat.es for Payment were issued and paymentv received from the Owaer,and that curtent paytntat shown heroin is now due. 1. ORIGINAL COIVTRACT SUM $ �g�872 Qp 2. Net change by Change Ordezs $ 0.00 CONfRACTO • Greystone Conslsuction Compazry 3. CONTRACT SLTM TO DATE(Line 1 f 2) $ 78,872.00 4. TOTAI,COMPLEfED dc STORID TO $ 45,072.Q0 DATE (Colmm�G on G703) By: �ti a . June 28,2018 5. RETAINAGE: a 5 %of Completed Work $ 2,253.60 State of MN County of: Scott (Column D+E on G703) Subscdbed and sworn to bafore me thia 28 b. %of Stored Material $ Notary P�blic• ��--� � KAREN M.BAUMANN Totall Retainage(Li es Sa+Sb or My CO�s�OII�� Y 1,2020 ,, �9 Notary PubliC '-. . '� State of i TotalinColumnIofG703) $ 2,253.60 ARCHITECT'S CERTIFICATE F',O � °��`°�s0131�0 6. TOTAL BARNED LESS RETAIIVAGE $ 42,818.40 In accordance with che Contract Documenta,based on on-eite observations and t}►e data (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Oavner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Arclutect's knowledge,information and belief the Work has progresaed as indicated, PAYNIENT(Line 6 from prior Certificate) $ 0.00 the quality of tbc Work is in accordance with the Contract Documente,and the Contractor 8. CLJRRENT PAYMENT DUE $ 42,818.40 is entitled to payment of the AMOiJNP CERTIFIEA. 9. BALANCE TO FII�TISH,INCLUDING RETAII�TAC�E $ 36,053.60 (Line 31ess Line 6) AMOiJ1VT CERI�IED...........$ 42,818.40 C 5 Y ADDTfIO 5 ED O (Attach acplanation if amount cerd;Jied d�ers from the amount applied.Inittal all�gures on this Totat changes approved Appltcalion and on the Condnuation Shed that are changed to conform with the mnount certifled) in 'ous months Owner ARCfIITECT: Total a ved tLis Month By: Dats: TOTAI.S �0.00 $0.0� This Certificate is not negotiable. The AMOUNT CERTIIrI3?D is pay,able only w the c:ontractor named rierem.lsauance,PaYmeat and accePtance oi payment are v�nmout NET CHANGES by Cltnnge Order $0.00 prejudice w auy rights of the Owner or Coahactor under this ConttacG �W1 DOCIiMENT 0702•APPUCATIQN ANp GEpT�FlCATION FOR PAYMENT•1992 EDRION•AW•m1g92 THE AMERICAN IIVSTITUTE OF AHCHITECT3,1735 NEW YORK AVE..N.W..WA�IWOTON.DC 200pB�bPe2 Uaers may obtain validation of this document by requeatlng a completed AIA Document D401-Certiflcatlon of Document's Authentictty from the Licensee.