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AIA° Dacvment G702'� - 1992 <br /> Application and Certiticate for Payment <br /> TO OWNER: City of Pequot Lakes PROJECT: Pequot Lakes Maintenance Garag• APPUCATION NO: 9-Partia)Retention DisMbutlon to: <br /> 4638 Main Street 4635 Derksen Road OWNER: <br /> Pequot Lakes,MN 56472 Pequote Lakes,MN 56472 PERIOD TO: 12/31/2018 ARCHITECT: <br /> FROM Boser Constructfon Inc. VIA CONTRACr FOR: General Construction CONTRACTOR: <br /> CONTRACTOR: 7135 5th Ave NE ARCHITECT: Widseth Smith Nolting CONTRACT DATE: FIELD: <br /> Sauk Raptds,MN 56379 7804 Industrfal Park Rd PROJECi NO: 8638 <br /> Baxter,MN 56425 <br /> CONTRACTOR'S APPUCATION FOR PAYMENT The undersigrted Conhactor cetqAes that to the best of fhe Cantractor's Krrowledge,iniortna8on�d <br /> ApplicaUon is made for payment,as shovm below,in Conneaion with the CoMract. be�ef fhe Work covered by this Apppca8on for Peyment haa been completed in ac�rdance wflh the <br /> AW Qocument GT03TM,Confinuation Sheet,is attached. Contrgct Dopiments,that ali amounb he+re been paid bq the Ccntractor for Work torwhtch previous <br /> 1.ORIGINAL CONTRACT SUM $ 894,Q00.00 �c�tes tor Paymem were issued and payments recelved torm tl�e Amer.and that current <br /> w.........�..._...__...._...__..........._.._......._....__....._.._.___ $ peyment shmm hereln Is now due. <br /> 2.NET CHANGES IN THE WORK _ <br /> 3.CONTRACT SUM TO DATE(UldE 1+2) ����r�����"µ����_���."'�""."�."'.__�.....__......_�._... $ 894,OOD.00 CONTRACTOR• <br /> 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703) ���������'��� ��µ�'������ $ _g�ggg�;�- gy; �, Date• �2�tq�l8 <br /> 5.RETAINAGE ..wµM.�µ..µ.�w�. g46,674.00 State of: nesota <br /> a. 5%of Completed Work(Column D+Eon G703) $ - County of: Benton <br /> b. po�o of Stored Material(Cofumn F on G703) $ . Subsc�ibed and sworn to "^""' <br /> Total Retainage(Lines 5a+5b,or Total ln Column 1 on G 703) a,, 1���IM fIBN�R� <br /> ..._....__...�...._..._.�..__......._..._.._.__ S - methis �9� ��- � �i lie-MlnnesaRa ' <br /> 8.TOTAL EARNED LE9S RETAINAGE � _y . <br /> ..B7�;b8�86� Notary Publf� -� , <br /> .........____....._..._...__....._......._.....»..._.......�......._.......... . �n� ; <br /> (Line 4 minus Line 5 Totaq 846,674.00 My Com ' n ex ua ���Zp-�---�°'31,2@0 <br /> , <br /> T..LESS PREVIOU3 CERTIFICATE FOR PAYMENT $ 834,657.64 ARCHITECTS CERTIFICATE FOR PAYMENT <br /> _..__._.....__........._..__......__..._............ <br /> (Line 6 ham pdor Certf6Cate) In accordanrs wi8�the Contrect Doamenls,based on on-slte observatlons end dre data comprising <br /> a.CURRENT PAYdIENT DUE • $ �43,929�8' ��aRPth;adon,the Architect certlAes ro the Own�that ro the best of Ne Art:hitects krtoxrledge, <br /> -..........................._.._._........._»_.......„.....__. „.........._.__.___„._».. ' intormaUon and badef the Wotk has progrebsed as indicated.the queQiy of 9�e Wotk Is in ecflordence <br /> 9.BALANCE TO FINISH,INCLUDING RETAINAGE 12,016.36 W��e�������e��������ro p�ent of tl�e AMOUNT <br /> 31,913.00 <br /> (Une 3 minus Line 6) $ �¢}3:gg— CERTIFIED. <br /> Line item-Div.32 Seeding=$15,413.00 12,016.36 <br /> Remaining punch list items=$10,000.00 AMOUNTCERTIFIED.........................................._ g �g�- <br /> ' ' ama es while under ne otiations=$6,500.00 (ABachexplanaryonUamomqcertlA¢ddiffers{romtheamountapplied.lnitlalsll�guresonthis <br /> CHANGE ORDER UMMARY ADDITIONS DEDUCTIONS Appticatlon and on the Contlnuatlon Sheet thet are chenged to cflrtform wfth the amount c�rtlAed.) <br /> Total changes approved in previous months by Owner $ - $ - ARCHRECT� /'/�/� _ <br /> Total approved this month $ - $ - gy; (-�'(��- p�e: 2J27/2019 <br /> TOTALS $ - $ - This ceNfh,ate is not nego8able.The AMOUNT CERTIFIED Is payabls onty to the Contraqpr <br /> named heretn.Issuartce,paymer�t and axepiance of payment are xrithout preJudfce to any dghts of U�e <br /> NET CHANGES Ch e Order $ _ Owner or Contracror urrd�this Contrect <br /> AIA Doeument G702"'-1992.Copyright�1953,1963,1965,1971,1983 and 1992 by The Ameripn Institute of Architects,AII Hahts reserved.WARNiNG:THIS AIA�Document is protected by U.S.CopyNght Law and <br /> Internatlonal Treaties.Unauthorized repraduction of distribution of this AIA°Document,or any portion of it,may result in severe dvil and criminal penalties,and will be prosecuted to the maximum extent possible <br /> under the law. <br />