09.03 Maintenance Facility Project Payment Certificate #4

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AIA� Document G702'� -- 1992 Applicarion and Certificate for Payment TO OWNER: City of Pequot lakes PROJECT: Pequot Lakes Maintenance Garag APPUCATION NO: 4 Distributlon to: 4638 Main Street 4635 Derksen Road OWNER: Pequot Lakes,MN 56472 Pequote Lakes,MN 56472 PERIOD TO: 7/31/2018 ARCHITECT: FROM Boser Construction Inc. VIA CONTRACT FOR: General Construction CONTRACTOR: CONTRACTOR: 7135 5th Ave NE ARCHRECT: Wfdseth Smith Noiting CONTRACT DATE: FIELD: Sauk Rapids,MN 56379 7804 Industrial Park Rd PROIECT NO: 8638 Baxter,MN 56425 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor eeNAes that to Ehe bast of the Conhactors Krrowtedge,IMarmatlon and Appliration is made for payment,as shown below,in cflnnection with the Conlract. beliei fhe Work covered by this App�ca8on for Pa�rtnent has been oortipleted in aaarorrdem:e wfth the AIA Document G703'"',ContlnuaUon Sheet,fs attached. Cantract Dowments,that au amamts have been paid by the Contrador tor Work ior wfllah previous 1.ORIGINAL CONTRACT SUM $ ��p� ��te�tar Payment were issued and paymems recelved form the Owrter,and that current ....._....__........__._..._....__...__.................._.._.............. peyment shawn herein is now due. 2.NET CHANGES IN THE WORK $ - .._......_._._.........._........_.__....._._._.........._.._.....__...._. 3.CONTRACT SUM TO DATE(LINE 1+Z) $ 894,000.00 CONTRACTOR: .._...__._.__.._.__....._._......._....___......w.....__.__..... 4.TOTAL COMPLETED AND STOREO TO DATE(Column G on G703) $ 421,782.70 By: Date: '?-Z3-rg 5.RETAINAGE ��µ��µ�� State of: . �!� a 5%oi Completed Work(Column 0+E on G703) $ 21,089.14 County of:(�,�-• b. Oo�p of Stored Mate�(al(Cnlumn F an G703) g . Subscribed and sworn to before ��~�� �Nsta�lf�'� Tatal Retainage(Lrnes 5a+5b,orTotal in Cofumn 1 on G703) $ 21,089.14 me this 2"s , �• ��hn.31,�0 .__...........__.._._......._.._....._...._.___._.... 6.TOTAL EARNED LESS RETAINAQE S 4�,683.56 Notary Public: � G� ._..__..._........._......._......._........._._....__.._......�.._._._. . � (IJne 4 minus Line 5 TotaQ My Commi i�s"on e res: "2� 7..LESS PRENIOUS CERTIFICATE FOR PAYMENT $ 219,852.80 ARCHII'ECTS CERTIFICA PAYMENT .._....__.._.__.___.............�..._......._.�.... (line 6 from priarCertiBcate) In ae�ordar�ce wfth the Cantract Doa►mems,b�ed on on-site abserva8ona and Me deta camP►isin9 t.CURREWT PAYMENT DUE $ 180�840.76 this applfcaBon.me�tea��nne�ro�,e o�ner n,a�ro tne ne�a me�r�nf��rs�now��a�e, _.__.....„._........._........_................._...._...__......_....�.......................w.. infortnaUon and belief the Wrnk has progtessed as indipted,fhe qualfty of the Woric is in accordance 9.BALANCE TO FINISH,INCLUDING RETAINAGE wnh the Contract Documents,and the Conhactor is e�Hltled to peymeM oi the AMOUNT (Line 3 minus Line 6) $ 493,306,qq CERTIFIED. At�otnur CERrIFlEo..........................................„ 5 180,840.76 (Attach explana�on ff amount c�tifled cRfters irom tlre amount appped.Initlal atl rtgu�es on thla CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Applicadm and on tha Contfivatlon Sheet that are chmiged ro confarm�Itlt the amamt osrtlfled.) Tatal changes approved In previous months b Ovmer $ • $ - ARCHITECT•• /�' /�j , Total approved thEs month $ - $ - By: ��...�C.l'(�G+�v�--` oate: 07/26/2018 TOTALS $ - $ - Thls cer811cate�not nego b1n.The AMOUNT CERTIFIED is peyable onty M the Contractor named herein.lssuance,payment and acxeptance o(payment are wRhout prejudkae to any righis ot fhe Owner or Contrastor undar this Contracl NET CHANGES b Ch e Order $ - AIA Document G702"-199L Copyrisht O 1953,1963,1965,1971,1983 and 1992 by The Ameripn Institute of Archkects.Afl ri�hts reserved.WARNING:THIS AIA G Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction of distribution of this AIA m Document.or any oortion of it,mav result in severe cfvll and criminal penalties,and will be orosecuted to the maximum extent possible under the law.