HomeMy WebLinkAbout4.j. Approve Payment #1, Contract #1988-5, Lift Station #5 �( !! �,
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APPL�xCa1llt�t �+Q� PAYNiNT � .•
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CITY PR�JECT NO: I9Z- 561� FILE NfJt t.��4IQ
PROJ�CT: �! �T ' �A'j-lON ��..j
CONTRACTOR: C�ILIZ. �.,O�uS�U�,,�pN CfJNTR1lCT D1�►TB: �..Lt �� SB _�
ISOL.S PfWV��G`� �*K� 1►pPLIC1�TI0N DATCst Z-!t�! SS�
�Df�if pR�►/AG6��d1 S�S347 FOR FERIOD 6NDIN(3: � � 3 f�_.^
Tatal Cocttraot Amount $��1 Z4p°p �Tatel Amount Sarned $ �S $Z>v ""
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Matsriei Suitably S�ored on Site,
�tot Incorporated into Work $
Contract Chanqe Order� No. Percent Complete $ --
Contrac� Ghange Order No. Percent Compiste $ -
Cor�tract Change Order No. Percer�t Compiete " g ^y�
OROSS AMOUNT DUB . . . . . . . . . . . . . . . . . . . . . . � �5,�$z.'o '�
I.888 �; RgTJ►IN110B . . . . . . . . . . . . . . . .. . . 8 I 7 7S_
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�ovMr ovs ro nxrs . . .... . . . . . . . .. . . . . . � 3, �z s'�
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I.�SS$ PRBVIt?tJ3 APPLICATIONS . . . . . . . . . . . . A O
1�.MOUNT DUE THIS �►PPLIC�ITION . . . . . . . . . . . S �3 L�jZ S �
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Riehar M. H ,
City 6�ginse,r i ireotor ot Fubliv Morks
� • � �1TION FOR PAYMENT - �ontinu�
T�tal Contract Arrbunt � 89,200. 00 Total A►nount Earned
3 35.5ttt�.�)t)
Material Suitably Stored on 5ite, Not incoporated intfl Work � t� �
Contra�t Change Order PJo. Percent.Complete �
$
Contract Change Order `!a, percent Complete �
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Contract Change Order t�o. Percent Complete y
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GROSS AN�UNT DUE. . . . . . . . . . , . . � 35,�c�t}.t)t�
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LESS 5 � RETAIhAGE. ,. . . . . . . $ 1 ,775.np
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AN�UNT DUE T0 DATE. . . . . . . . . .. . . $ 33�72�.��p ,.
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LESS PREViOUS APPIICAtIONS. . . . . $ t�
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C4��TRt�CTQR'S aFFIDt#VIT A��1NT QUE THIS APPIICATiOFt. . . . $ 3 72r,tt0
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The undersigned Contractor hereby swears under penalty of perjury that {2) ail previous �rogress.
PaY�Q��s received from the Qwner on account nf wvrk performed under the contract r�eferred tn
ebvve have been appiied by the undersigned to dfscharge tn futi al1 obtiqatlon� of the i�r�der_
signed incurred in connection with work cvvered by prjor Apptications far Payr�t�t under said
contract,
material and equipment incorporated in said Project or otherwise tisted in Qr covered�by#this
Apptieation for Payment are free and ctear of alI liens, claims, security interests ar�d
encumbrances.
f�dted _ February 6 , 19 89 C?rr Cons�ructa,on
• Contr r .._��
i
8� Vice I't•e�si�ic�rit
Name and Ti tle _.�
�OUNTY OF IIENNFPIN � SS
�TATE OF MiNN�SOTA )
3efore me on this 6_ th day of , 19 ,�
D. Daniel Orr � ,� personally ap�eared
.�nd say that he is the nown to �, w o being duly sw4rn, did de�ose
vice President Of the Contractor aboue mentioned;
Office
that he executed the above App)ication for Payment and Affidavit on behatf of sald Contr-actor;
and that all of the statements contained therein are true, correct and complete.
My Commi s s i on Exp i r `t�°, tUbiTH A.ORR
�� iF�' NOTIIRY►UlUE..MINNESOTA
HiNNEPlN CpUNtY N0�8i"�t PUb c
�Idy eommission expiret f�b. 33,1991
The undersigned has checked the on rac Rpplication far Payment shown above. A part of
this Application is the Contract�r's Affidavit stating that all previous payments to h1m
under this Contract have been applied by him to discharge in fuli al1 af his ablfgations in
connection with the work covered by a11 prior Applications fvr Payment.
In accordance with the Contract' the undersigned approves payment to the Contractor of #!�e
Amount Oue.
Date �-�}� �'j9 SNORI _OTI �i i1DRICY. Ot, IPt�:
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Paq� 3 of 3
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