09.03A Maintenance Facility Project - Greystone Construction Payment Certificate #2

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�1PPLICATION AND CERTIFICATION FOR PAYMENT AIADOCUMENTG702 PA�EONEOF 2 PAGES TO OWNER: PROJECT: APPLICATION NO 2 Distribution to: � City of Pequot Lakes Pequot Lakes Maint. APP.DAT'E 09/04/1 S X OWNER 4638 Main Street Department Garage X ARCHITEGT PequotLakes,MN 56472 Project#0130B0063.000 PERIOD TO: 08/31/18 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Greystone Constn�ctlon Comparry Architect Name , S00 S.Marschall Road.Suite#300 Architect Address PROJECT NOS: FS18-8170 Shakopee,MN 55379 A�chitect Address CONTRACf FOR: CONTRACT DATE 03/Ol/18 CONTRACTOR'S APPLICATION FOR PAYMENT The undeisigned Contiactor certifies that to tho beat of tho Conuactor's Imowledge, Application is made for payment,as shown below,in connectivn with the Conuact. information and belief die Work covered by thia Application for Payment has been Continuation Sheet,AIA Document 0703,is attached. complcted in accordance with the Conh�act Documents,that all amounts have bcen paid by the Contractor for Work for wldch previons Certificates for Payment were issued and paymenLv received&om er,and tbat cuaent paymmt ehown herein is now dne. 1. ORIGINAL CONTRACf SiJM g �g�g�2.Qp 2. Net change by Change Ordere $ 0.00 CONTRAGTOR (ireystone Construction Company 3. CONTRACT SUM TO DATE(Lino 1 f 2) $ �g�872,pp 4. TOTAL COMPLETED&STORED TO $ 63,572.00 DATE (Column G on G703) By: '''�� D : Saptember 4,2018 5. RETAWAGE: � a. 5 %of Completed Work $ 3,178.60 State o£ County of: Scott (Column D+E on G703) Subscn'bed and sworn to be��re me this 4 p g b. %of Stored Matoriai S Not�rv pubu�� a�' KAREN M.BAUMANN (Column F on G703) M Commission Tota1 Retainage(I,ines Sa+y'(�� y �P�� January 31,2020 ..� '� Notarq Public TotalinCol�mnIofG703) s s,��s.6o ARCHITECT'S CERTIFICATE FO � �D1�12D20 6. TOTAL EARNED LESS RETAIl�TA(iE $ 60,393.40 In accordance with the Conhact Documents,bnsed on ori site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Arclutxt certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTII7ICATES FOR ArclritecNs]mowledge,informa6on and belief the Work has progressed as indicated, PAYIVIENT(Line 6 from prior Certificate) $ 42,818.40 the quality of the Work is ia accordance with the Coatract Documents,and the Coauactor 8. CURRENT PAYMENT DUE S 17,575.00 is entiUed to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAWAGE $ 18,478.60 (I.ine 31ess Lino� AMOUNT CERTIFIED_..........$ 1'7,575.Q0 C E O ADD N D S (Attach explanation if a»wunt certified differs from the amount applied.Initial all es on th9s To changes appraved �� Application and on the Continuatton Sheet that are changed to conform with the a»wunt cerAified) in 'ous months by Owner ARCHITECf: Total ed thie Month By: Date: TOTALS 50.00 $0.00 This Certificate is not negotiablc. The AMOLINT CERTIFIRD is payable only to the (;onhactor named heran.lssuance,Paymeat and acceptance o2 payment az�without NET CHANGES by Change Order $0.00 prejudice to any rights of the awwnier or Contractor under this Contrac� AIA DOCUMENT Q7Q2•MPLICATION AND CFATIFlGTiQN FOR PAY&�NT•18Q2 mIT10N•AU•m1B92 THE/IM�RICAN WSTIME OF MCHITECT8.1736 NEW YOHK AVE.N.W..WA9HIN�TON.DC 20008�52i2 Users may obtaln valtdatlon of thls document by requesting a completed AIA Document D401 -Certlflcation of Document'a Authenticlty from the Ucensee.