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AIA° Document G702� -- 1992 <br /> Applicarion and Certiticate for Payment <br /> TO OWNER: City of Pequot Lakes PROIER: Pequot Lakes Maintenance Garage APPLICATION NO: 10-Adjusted Final DisMbution to: <br /> 4638 Main Street 4635 Derksen Road Invoice OWNER: <br /> Pequot Lakes,MN 56472 Pequote lakes,MN 56472 PERIOD TO: 7/1/2020 ARCHITECT: <br /> FROM Boser Construction Inc. VIA CONTRACT FOR: General Construction CONTRACTOR: <br /> CONTRACTOR: 7135 Sth Ave NE ARCHITECT: Widseth Smith Nolting CONTRACT DATE: f1ELD: <br /> Sauk Rapids,MN 56379 78041ndustrial Park Rd PROJECT NO: 8638 <br /> Baxter,MN 56425 <br /> CONTRACTOR'S APPUCATION FOR PAYMENT The undersigned Cantractor certlfles tl�at to the Dest of the Contraclors Knowledge,infarnatlon and <br /> AppliCation is made for payment,as shown below,in Connection with the ConUaCt. be�ie�the Work covered by tl�is ApplicaUon tor Payment has been completed in accadance wflh the <br /> AIA Document G703TM',Continuation Sheet,is attached. Conhact Documenls,lhat aN�naunts have been pald by the Conhactor for Wak for which prev(ous <br /> 1.ORIGINAL CONTRACT 3UM $ 894,000.00 ����Payment were issued and paymeMs received tam the Owner,and that current <br /> ...................... ......................................__..... payrt�ent shown hereln is now due. <br /> 2.NET CHANGES IN THE WORK ........_............_. E <br /> ..........._.............................................................__.........__... <br /> 3.CONTRACT SUM TO DATE(LINE?+p) $ 894,000.00 CONTRACTOR: <br /> ... ........................................................................... <br /> 4.TOTAL COMPLETED AND 3TORE0 TO DATE(Cofumn�on�703) $ 894,000.00 ey:_ Date: T-(-Lota ' <br /> 5.RETAINAGE State of: ne ta <br /> a. 5%of Completed Wak(Column D+E on G703) $ - County of: Benton �K M�.�K <br /> b. 0�ofStored Material(Column Fon G703) g _ Subscribed and sworn to before � p�P�"�` � <br /> Totat Retainage(Lines 5a+5b,or Total in Cofumn I on G703) $ - me this 1* day of ��, . �����'� <br /> ....................._........................................... . <br /> 6.TOTAL EARNED LESS RETAINAGE $ 894,000.00 Notary Public: <br /> ............_._............................................................................. . <br /> (Line 4 minus Line 5 Totaq My Comm� n exp' anuary 31st,2025 <br /> T..LESS PREVIOUS CERTIFICATE FOR PAYMENT 3 862,087.01 ARCHRECTS CERTIFICATE FOR PAYMENT <br /> .................................................................. <br /> (Lin@ 6 Irom p►rW Cerfi�Cete) In acxordance wIM the Contract Documents,based on on-site observatlons and tl►e data comDrising <br /> 8.CURRENT PAYMENT DUE $ 31,912.99 ��s�plic�tion,l�e Arctbtect oertifies to the Owner that to the best o1 the Architecls knawledge, <br /> .........................................................._...................................................... <br /> infamation and belief the Wak has progressed as indicated,the quaNty of tl�e Wak is in accordance ` <br /> 9.BALANCE TO FlNISH,INCLUDING RETAINAGE wim the Contract Documents,and the Canractor is entltled to payment of the AMOUNT <br /> (Line 3 minus Line 6) E _ CERTIFIED. <br /> AMOUNT CERTIFIED............................................ S 31.912.98 " <br /> � <br /> (Altach explanatiort H anount certified differs from the amaunl applied.Initlal ali Agures on this <br /> CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Applica�on anA on the Con6nuadon Sheet that are d�anged to c:ontorm with Ihe amount certifled.) <br /> Total chan approved in prevaus months by Owner $ - S - ARCHITE ) �,�/�' /�, � <br /> Total approved this month g - 3 - By: ��-�`�`--�'--�LX(.C,�v�----_ pace: 7/20/2020 <br /> TOTALS $ - S - This certificate is not negotfable.The AMOUNT CERTIFIED is peyable aily to the ConUector <br /> named herein.Issuance,payment and acceptance of payrtient a�e wkhout preJudice to arry righls of the <br /> NET CHANGES b Cha e Order $ _ �e�a�aacta under this Contract. <br /> � <br /> AIA Dotume�t G702"'-1992.Copyright m 1953,1%3,1965,1971,19$3 and 1992 by The American Institute of Architects.All rights reserved.WARNING:THIS AiA�Document is protected 6y U.S.Copyright Law and <br /> International Treaties.Unauthorized reproduction of distribution of this AIA°Document,or any portion of it,may result in severe crvil and criminal penalties,and will be prosecuted to the maximum extent possible <br /> under the law. <br />