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AIA� Document �702� - 1992
<br /> Application and Certificate for Payment
<br /> TO OWNER: City of Pequot Lakes PROJECT: Pequot lakes Maintenance Garag APPUCATiON NO: 7 Distribution to:
<br /> 4638 Mafn Street 4635 Derfaen Road OWNER:
<br /> Pequot Lakes,MN 56472 Pequote Lakes,MN 56472 PERIOD TO: 10/31/2018 ARCHITECT:
<br /> FROM Boser Construction Inc. VIA CONTRACT FOR: General Construction CONTRACTOR:
<br /> CONTRACTOR: 7135 Sth Ave NE ARQiITECT: Widseth Smith Nolting CONTRACT DATE: FIELD:
<br /> Sauk Rapids,MN 56379 7804 Industrial Park Rd PRQ1ECr NO: 8638
<br /> Baxter,MN 56425
<br /> CONTRACTOR'S APPLICATION FOR PAYMENT The urtdersigned Contractar certlfles th8t to tha best ot the Contractors Knawladge,intarmatlan and
<br /> App�caUon fs mede for payment,as shown betow,in connection with the ContracL beltei the Work covered by this Applicatlon for Payment has been comptet�l tn aa�rdance wfth the I
<br /> AIA DocwmeM G7Q3TM',ConUnuatlon Sheet,is attached. �����������nts have treen pa►d by the Contraetor fa Wmk tor whlcfi prevtous ,
<br /> 1.ORIGINAL CONTRACT SUM $ ���� ����ior Payment were lasued and peyments recehred form Ihe Uxner.and that current �
<br /> _»...__...._....._.._._._.._.......».___....._.._...__.__..._._.. payment shown her�n is nav due.
<br /> 2.NET CHANGES IN THE WORK ....___._._ $ '
<br /> ____.....rW..........._,...._......._W....___..._._. �
<br /> 3.CONTRACT SUM TO DATE(UNE 1+2) $ 894,000.00 COIVTRACTOR: -�
<br /> 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703)��.��..�..�.�g73,587.00$ 994,88�'QO' By: Date: •�h 24.1P �
<br /> .___.._._..___._...._ �
<br /> 5.RETAINAf3E State of: Minne ta '
<br /> a. 5°�oiCompleted Work(Column D+Eon G703) $ _44�869i-43,679.35 County of: Benton -� �,,,,,
<br /> ��d+ ti,�� NEA7HE�MIfI� r
<br /> b. 0°!0°��0red Material(Column F on G703) $ _ Subscribed and sworn to before
<br /> "�; �an►v+,�c_�,m,�oa, �
<br /> Totat Retainage(Unes 5a+5b,or Total in Column 1 on G703) 43,679.35$ �6t me this 2�* day of '
<br /> ._.................__.._.._._.............._....._...... � NhCoa�SlonFxpi�eslfn.31,2@0
<br /> 6.TOTAL EARNED LESS RETAINA(3E .,,...,,__.___.......__.�.............�._...__..._.„......829,�907.65$ � Notary Publi�—���
<br /> (Llne 4 mrnus Line 5 Tota� My Com�exp es: � January 31st,2020
<br /> 7»LESS PREVIOUS CERTIFICATE FOR PAYMENT 644,853.53$ h64a$9-t5 ARCHRECTS CERTIFlCATE FOR PAYMENT II
<br /> __......__......._...._..._....___M...._..___..
<br /> (Line 6 from prior CeRiflcate) In accadance wfth the Contract Documents,based on on-s�e observatlons and the data campdsNg
<br /> d.CURRENT PAYMENT DUE 185�054.12$ �$4,593:8�t ��s appncadnn,the Architect certlfles ro the Oamer that ro the best of tAe Arch(tects knawiedge,
<br /> .._......____.._.._.._._._�W._......___..._..�..... informatlon and benef the Work has pragressed as Mdtcated.the qua4ty of the Work Is in accoMence �
<br /> 9.BALANCE TO FI�IISH,INCLUDINO RETAINAGE � with 9�e Contract Documents,and the Contraeror is enHHed to payment ot the AMOUNT ��
<br /> (Line 3 minus Une 6) $ 64,092.35�4Mi88:9'i' CERTIFIED. �
<br /> ANtOUNT CERTIFIED............................................ 3 185,054.12'�$4,593� !�
<br /> (Attad►explanadon N amount cer6Aed dHt�s from the amouM applied.INdat all 6gures on thfs �
<br /> CHANGE ORDER&UMMARY ADDITIONS DEDUCTIONS Appqcatlon and on the CondnuaUon Sheet that are changed to coniorm w�h tlre mnwnt certltled.)
<br /> ;
<br /> Total changes approved in previous mo�hs by Oumer $ - $ - ARCHRECT:• y/�' /y� �
<br /> Total approved this month $ - $ - sy: �._..,,/�i�.(�(.�c✓�� oate: 11/1/2018
<br /> TOTALS $ - $ - This cer�icate Is not nega abte.fie AMOiJNT CERTIFIED Is payable cnly M the Contra�or
<br /> named hePein.Issuance,payment and acceptance of paymerd are vrithout prejudice to any dghfs of the
<br /> Oamer cr Contracror urtder this Contract
<br /> NET CHANGES Ch e Order $ -
<br /> AIA Oocument G702"-199i Copyright O 1953,1963,1965,1971,1983 and 1992 by The Amerkan Institute of Archttects.A[I�Ishts reaerved.WARNING:THIS AIA°Document is protected by U.S.Copyrlght Law and
<br /> International Treaties.Unauthorized reproduction of distribution of this AIA°Document,or any portfon of�t,may result In severe civll and criminal penalties,and wiil be prosecuted to the maximum extent possible
<br /> under the law.
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