09.03A Maintenance Facility Project - Greystone Construction Payment Certificates #3 & #4

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APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMEIVT G702 PAGE ONE OF 2 PAGES TO OWNER: PROJECT: APPLICATION NO 3 Distribution to: City of Pequot Lakes Pequot Lakes Main� APP.DATE 10/11/18 �X OWNER 4638 Main Street Department Garage X ARCHITECT PequotLakes,MN 56472 Project#tJ130B0063.000 PERIOD TO: 10/11/18 X CONTRACTOR FROM CONTRACTOR: VIA ARCffiTECT: � Greystone Construction Comparry Architect Name � S00 S.Marschall Road,Suite#300 Architect Address PROJECT NOS: FS 18-8170 Shakopee,MN 55379 Architect Address CONTRACT FOR: CONTRACT DATE 03/Ol/18 CONTRACTOR'S APPLICATION FOR PAYM ENT The undersigned Contractor certifies that to the best of the Conh�acto�'s l�owledge, Application is made for payment,as shown below,in connection with the Contrac� infora►ation and belief the Work covered by this Application for Payment has been Continuation Sheet,AIA Document G703,is attached completed in accordance with the Contract Documents,fl�at all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner,and that current paymern shown herein is now due. 1. ORIGINAL CONTRACT SUM $ 7g,g72,Q0 2. Net change by Change Orders S 0.00 COIVTRACTO . Greystone Construction Company 3. CONTRACT SIJM TO DATE(Line 1 t 2) $ 78,872.00 4. TOTAL COMPLEI'ED dc STORED TO � 78,872,00 DATE (Column G on G703) By: Date: October 11,2018 5. RETAINAGE: a 5 %of Completed Work $ 3,943.60 State of: MN County of: Scott (Column D+E on G703) Subscribed and swom to be �re me this 11 day of October,2018 b. %of Stored Material $ Notary Public: (Column F on G703) My Commission expires: January 31,2020 �*+�, KAREN M.BAUMANN Total Retainage(Lines Sa+Sb or �"' a, TotalinColumnIofG703) $ 3,943.60 ARCHITECT'S CERTIFICATE FO :I teotMinnesota � E�I�ission Expires 01f3112020 6. TOTAL EARNED LESS RETAINAGE $ 74,928.40 In accordance with the Conhact Documents,based on on-si (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the bwaer that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's l�owledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Cerlificate) $ 60,393.40 the quality of the Work is in accordance with the Conh�act Documentg,and the Conttactor 8. CURRENP PAYMMEIVVT DITE $ 14,535.00 is entifled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 3,943.60 (Line 31ess Line� AMOiJNT CERTIF�D...........$ 14,535.00 CHAN E ORDER ON DED ON (Attach ezplanation if amount certified d�ers from the amount applied.Initia[al!figures on thir Total changes approved Application and on the Continuation Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHTl'ECI': Total appmved this Month By: Date: TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the C:ontractor named herem.lssuance,payment and acceptance oY payment are wnthout NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT�702•APPUCATION AND CERTIFlGTION FOR PAYMENT•1992 EDITION•AIA•m1892 THE AMERICAN INSTIME OF ARCHITECTS,1735 NEW YORK AVE.,N.W.,WASHINGTON,DC 200065?B2 Users may obtaln valldatlon of this document by requesting a completed AIA Document D401 -Certification of DocumenYs Authenticfty from the Lfcensee.