09.03 Maintenance Facility Project Payment Certificate #5

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AIA� Docuanent G702�`M - 1992 A�plicarion and Certificate for Payment TO OWNER: City of Pequot lakes PROJECT: Pequot Lakes Maintenance Garag APPLIGITION NO: 5 Distribution to: 4638 Main Street 4635 Derksen Road OWNER: Pequot Lakes,MN 56472 Pequote Lakes,MN Sfi472 PERIQD TO: 8/31/2018 ARCHITECT: FROM Boser Construction Inc. VIA CONTRACT FOR: General Construction CQNTRACTOR: CONTRACTOR: 7135 5th Ave NE ARCHITECT: Widseth Smith Nolting CONTRACT DATE: FIELD: Sauk Rapids,MN 56379 7804 Industrial Park Rd PROJECT NO: 8638 Baxter,MN 56425 CONTRACTOR'S APPUCATION FOR PAYMEN'f The underaigned Conbactor ceNQes that M the best of the ConhactoPs Knawtedge,Iniormatlon and Applicatlon is made for paymeM,as shown below,in connectlon with the Contract bellef the Work covered by this Appttcatlan tor Payment has been completed in�cordam�with tAe AIA Document G703TM,Continua6on Sheet,is attached. ��Q�ments.that all amourits heve been peld by the Contracta tor Work tor which previous 1.ORItiINAL CONTRACT SUM $ 894,OQ0.00 ��Payment xrere Issued and payments recslved farm the O�mer.arM that current .�__..........___.__.__....__.__._.___........._....__......... Peyment shown herein is now due. 2.NET CHANGES IN THE WORK $ - ........._.._.._..___._......._....._..._.__....._.._.._._......_ 3.CONTRACT 3UM TO DATE(LINE 1+2) $ 894,000.00 CONTRACTOR: 4.TOTAL COMPLETED AND STORED TO DATE(Cofumn G on G703)��_.��w.��.��..�w~ $ 521,778J0 By: Date• �2�•� ._....._.._...__._......., �� • S.RETAINAGE State of• �... a. 5°!0 0�Completed Work(Column D+E on G703) $ 26,088.95 County of:�'x�.4� ��M�� b. Oo�of Stored Materiai(CMumn F on G703) a _ Subscribed and sworn � ��f►PuYk-Mi�u� Total Retainage(Lines 5a+5b,orTotal in Column 1 on G703) $ 26,088.95 me this �� ` y � ' �� ......_.......__.__._.._......._.._._.....___... 8.TOTAL EARNED LESS RETAI(t1A(3E $ 495,669.75 Notary Publ . ,� .__..._......._._._......._.._.._..._.__.........__.__..._.._._..._, (Lir►e 4 minus line 5 Tofaq My Co ion res. 3 7..LESS PREVIOUS CERTIFICATE FOR PAYMENT $ 400,693.56 ARCHITECTS CERTIFI F PAYMENT ........__............._...__.......»._............_._.. (Line 6 hom prior Cer6ficate) In aa�rdance with the Contrad Documents,based on on-sfte observaflona and me data comprlshig t.CURRENT PAYMENT DUE $ 94,996.19 �is app�catlon.the ArehitQct aertlfies to the Owner that ro the best of the Archttects knonaledge, ........„....._..._..........._.._._.._..._.__.........�.__...._......_.__.._......._....., iniormatlon�d belieithe Work has progressed as inmcated.�,e�ua�ry or u�e wodc�s m ac�ordance 9.BALANCE TO FlI�ISH,INCLUDING RETAINAGE wffh the Cnntrect Documents,and fhe Contraccor is eMitled to payment otthe AMOUNT (Line 3 mrnus Line 6� $ 398,310.25 CER7IFlED. uu►ouHr Cea'nFlEo............................................ s 94,996.19 � (AttaCh expiar�ation H amount ceNtfed difters from the amount applied.Inidal all 4gures on this I CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Applicetlon and an the Contlnuatlon Sheet that are changed to ccnMrm vriM U�e mrtamt certfied.) I Total changes approved in previous months by Owner � - $ - ARCFpTECT:• /�' /�j � Tota1 approved this month $ - $ - By: �'-��•..-7�1�f.'Lf.�--1 aaro: 08/24/2018 � TOTaLS $ - $ - This cerBncete is not nego6ap�e.rne rJ�louNr ceRnFlED ts payeb�e only ca ure contr�tor named herein.Issuance,Payment and acceptamce of payment are wAhout prejudice to any rights ot Me j NET CHANGES b Chan e Order $ _ �e��C�tractar under this ConVact. ± AIA Document G702"-199L Copyright�1953,1963,1965,1971,1983 and 1992 by The American Ins[itute of ArchRects.All riahts roerved.WARNING:THIS AIA m Document is proteded by US.Copyright Law and � International Treaties.Unauthorized reproduction of d�stribution of this AIA�Document,or any portian of it,mav result in severe civil and criminal penaltles,and will be prosecuted to the maximum ex[ent posslble underthelaw, 4 , �