09.01B Additional Public Works Facility Project Payment Certificate

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� ' AIA� Dacument G702'� - 19�2 Application and Certificate for Payment TO OWNER. City of Pequot Lakes PROJECT. Pequot Lakes Maintenance Gara�• APPLICATION NO: 9-Partial Retention Dtstribution to: 4638 Main Street 4635 Derksen Road OWNER: Pequot Lakes,MN 56472 Pequote Lakes,MN 56472 PERIOO TO: 12/31/2018 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 Industrial Park Rd PROJECT NO: 8638 Baxter,MN 56425 CONTRACTOR'S APPLICATION FOR PAYMENT Tha undersigrred Contractor certlAes fhet to ffie best o{6�e Canhe�ors Knawledge,informa�on and ApplicaUon is made for payment,as shovm below,in connecdion with the ConUact. betlaf the Work covered by this ApRpcaBon(pr Payment has been completed tn accordence wsh the AIA Document G703n",Contlnuatlon Sheet,is attached. �tract Documents.that aA amouMs hare been paid by the Contreaor for Work for which previars 1.ORIGINAL CONTRACT SUM $ 894,000.00 cernncates tor Payment were Iss�,ed and paymenb rece�ved torm the owner,and that current ......_._.............._._......__..........___._._....__._....._.._._.._ $ peyment shosm hmeln is now due. 2.NET CHANGES IN THE WORK _ ___.__._.�..._�.___.._....._.._....._....__....__._..__._._ 3.CONTRACT SUM TO DATE(LINE 9+p) $ 894,000.00 CONTRACTOR: ._.._...._._...._..._.___....._........._...__..._._._„..._.._..... 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703) $ �7:Op- gy; Date:�_, �'��E Wµµ�� 862.087.00 State of: nesota a. 5%af Comptetad Work(Column D+E on G703) $ - County of: Benton b. 0%°f�0�Material(Column Fon G703) $ _ Subscribed and sworn to � 1e TIQMt�QR-/EVER ; Totat Retainage(Lines 5e+56,or Tofal in Column I on G703) $ - me this y�L ' 6.TOTAL EARNED LESS RETAINAGE .._....._r..�.......r.^..Y.�.^..��w�.�m�...��µ�.�....._w�.'� $ �g,�g�:80' Notary Publi�;�.. �. -' `�1�qe-Mirtnesaea (Line 4 m�nus Line 5 Tote� 86� My Ccm�ex j .ua �� , 7..LESS PREVIOUS CERTIFICATE FOR PAYMENT ��Y�� $ 834,657,64 ARCHITECTS CERTIFICATE FdR PAYMENT (Line B from pdor Certil�cate) .�...___.._.__.._.„_......_...... In ecxordanco wifi the Contrect�ocuments,based on an-sfte obaenradons end the dam comprismg � Q.CURRENT PAYMENT DUE • $ .A3,,9� this app�Cadon.the Ardiftect certlfles ro the Owner that ro the beat W the Mchitects knowiedge, �...�._........_.............._._w.._.._..........._...._._..........„....,...»..._......»._... informatlon and benef the WOrk has progreased es indic�ed.the quBBty aFthe Wotk is in ed:ordm►ce 9.BALANCE TO FlMSH,INCLUDING RETAINAGE 27,429.36 �th�e��d the ConVector is enfftted to � (Line 3 minus Line 6) $ 3��9�8. paYment otthe AMOUNT CERTIFIED. I Line item g Div.32 Seeding=$15,412.00 N S 2�42�9.�3� II Remamin unch list items=$10,000.00 ANIOUNTCERTIFlED........................... idatedDama eswhileundernegotiafions=$6,500.00 (q(�ry�p��famouMcertlfleddiHersfromtheamountapp4ad.irtidalalitlgureson6�la CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Appllcadnn and on the Cantlnuadon Sheet that are chartged to conform yrRh tlre amount ceAiGed.} '� Totai changes approved in previous rtronfhs by Owner $ - g ARCHITECT::� l��G+�� Total approved this month $ - $ - ey. "�-� Date; 2/27/2019 TOTALS $ - $ - This car6flcate is not rtego6aDte.The AMOUNT CERTIFlED is payebte only to the Conhactar named herdn.Issuance,payment and ecxeptence of payment are without prejudice to any dghts oi the NET CHANGES Ch e Order $ _ Owner or Corttreclor under this ContracL AIA DocumeM G702"-1992.Copyright�1953,1963,1965,1971,19E3 and 1992 by The Amehcan Institute of Arthitects.All ri�rcserved.WARNiNG:THIS AIA�Document is protected by U.S.Copyright Law and '� Internatlonal Treat�es.Unauthorized reproductfon of distribution of this AIA°Oocument,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. f