09.01B Public Works Facility Project Payment Certificates

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AIA� Doeument G702� - 1992 Application and Certificate for Payment TO OWNER: City of Pequot Lakes PROIECT: Pequot Lakes Maintenance Gara� APPUCATION NO: 8 Distributlon to: 4638 Main Street 4635 Derksen Road OWNER: Pequot Lakes,MN 56472 Pequote Lakes,MN 56472 PERIOD TO: 12I31/2018 ARCHITECT: FROM Boser Construction Inc. VIA CONTRACT FOR: General Construction CONTRACTOR: CONTRACTOR: 7135 5th Ave NE ARCHITECT: Widseth Smith Nolting CONTRACT DATE: FIELD: Sauk Rapids,MN 56379 7804 Industriat Park Rd PROJECT NO: 8638 Baxter,MN 56425 CONTRACTOR'S APPLICATION FOR PAYMENT The underslgned Contractor eertlfies that to the best of the Contradors Knowlsdge,intom�aVon and Application is made tor payment,as shown below,in connectian with the ConVact. beUef the Work cflvere�by thb App�c�don for Payment hav been compteted In aa�rdm�ce wkh the AIA Documertt G703"',Continuation Sheet,is altached. Contrect Documents,thet all amoums have been pald by Ihe Contractor ior VNork tor whlch previous 1.ORIOINAL CONTRACT SUM $ �� ertiftcates tor Payment wae lssued end paymenb received torm the Onmer,and that current ..»»„...._........_...._.__....................._......................._......... Papnent ahown herefi 18 naw due. 2.NET CHANQES IN THE WORK $ - ._._....»....»........_................._.............__..._..._�...__....... 3.CONTRACT SUM TO DATE(L/NE 1+p) $ 894,000.00 CONTRACTOR: 4.TOTAL COMPLETED AND STORED TO DATE(Cofumn G on G703) µ�� w�� $ 878,587.Q0 By: Date:�,� 5.RETAINAQE •-�•��-MM�_...M. State of: M esota a 5qo�Completed Work(Column D+Ean G703) $ 43,929.36 County of: Benton MFATlIER Ml1��11EI1 b. Oo�o of Stored Material(Column F on G703) $ . Subscribed and sworn to before ; .�ry�_�� Total Retainage(Llnes 5a+5b,or Totalm Column I on G7Q3) $ 43,929.36 me this �� N � .�h�� ..._....__....._._�..........._....._....._.._....... , B.TOTAL EARNED LESS RETAINAGE ...µ.....��...�.....��.� S 834.857.64 Notary Publ �� (Line 4 minus Lfne 5 Totel) .��µ....�W�w��.r�._�.�.�. My Com ��o�n expltEsr�. January 31st,2020 7..LESS PRE1lIOUS CERTIFICATE FOR PAYMENT $ 829,907.64 ARCHITECTS CERTIFICATE FOR PAYMENT w_............__..._......_.._.._.............._Y... In accCrdance wfth the Contrect Doaments,based on on-slte observa6ons mM the data compdshig (Une 6 from prior Cerdficate) e.CURRENT PAYMENT DUE $ 4,750.00 �'�aPpAcatlon,the Art�itect ceAifles to fhe Owner thet to fhe bsst of the Architects knawledge, ..._w...M.....„.._„_........_.�......_._..........._...........__....�......_......_.„...w Informatlan end belief fhe Wwk has progressed as tndlcated�the qualliy of the Wark�in accordance 9.BALANCE TO FpVISH,INCLUDING RETAINAGE urith the Contract DocumeMs,and the Conbactor is entltled to paymeM ot tha AMOUNT �I (Lina 3 mtnus Llne 6) $ 5g,3q2,3g CERTIFIED. Ad10UNT CERTIFIED............................................ $ 4,750.00 (Atlach explana9on H amount ceNAed ditfers fram the amount appqed.InfEal�I ftgures on tlds CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Appecatfon and on the ConUnuatlon Sheet that are changed to coMorm with the amourd ce�tlfled.) � T�tel ch es approved in previous monU�s b Owner $ - $ - ARCHREC� /'n/� . i Total approved this month $ - $ - By. «�i��'� Date: 2J27/2019 � TOTALS S - $ - This certlflcate Is not negoUable.The AMOUNT CERTIFIED is parable only to the Contractor j named herein.Issuance,payment atM axeptam:e ot paymeM are wlthout preJurDce ro any dghts of the ;� NET CHANGES b Chan e Order $ _ ��tracror under tlds Contract � AIA Document G702"-1992.CopyrigM m 1953,1963,1965,1971,1983 and 1992 by The American InsHtute of Architec[s.All�ights►esetved.WARNING THIS AIA°Document is protected by US.CopyNght Law and � International Treaties.Unauthorized reproduction of distribution of this AIA�'Document,or any portion of it,may result in severe civil and viminal penaltles,and will be prosecuted to the maximum extent possible i underthelaw. � �I I