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Home My WebLink About4.d. Application for Payment #8, New City HallCHANGE ORDER SUMMARY LESS PREVIOUS CERTIFICATES FOR PAYMENT ....... $ ' information and belief the Work covered by this Application for Change Orders approved ADDITIONS APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 0702 PAGE ONE OF PAGES M TO (Owner): CITY OF ROSEMOUNT PROJECT: ROSEMOUNT CITY HALL APPLICATION NO: 8 Distribution to: p 1367 145TH STREET E. State of: unty o�IN 0 OWNER Approved ROSEMOUNT, MN. 55068 PERIOD FROM: 12/1/$6: ❑ ARCHITECT Number Date Approved TO: 1/7/87 Z7 CONTRACTOR ap accordance with the Contract Documents, based on on-site obser-ARCHL 1,597 p #3 ATTENTION: CONTRACT FOR: ARCHITECT'S El #4 the quality of the Work is in accordance with the Contract Docu- ments; and that the Contractor is entitled to payment of the AMOUNT PROJECT NO: CERTIFIED. N CONTRACT DATE: AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT• APRIL 1978 EDITION ,• AIA® • 0 1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE,-N.W., WASHINGTON, CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document GM, is attached. CHANGE ORDER SUMMARY LESS PREVIOUS CERTIFICATES FOR PAYMENT ....... $ ' information and belief the Work covered by this Application for Change Orders approved ADDITIONS DEDUCTIONS in previous months by previous Certificates for Payment were issued and payments received Owner from the Owner, and that current ayment shown herein is now due. TOTAL State of: unty o�IN C A 20 NO CO . 1$' ITE 189, MPLLS. M. 55427 Approved this Month 5,236 ate: 1Fres. Number Date Approved #1 #2 accordance with the Contract Documents, based on on-site obser-ARCHL 1,597 vations and the data comprising the above application, the Architect #3 certifies to the Owner that the Work has progressed to the point 3,200 indicated; that to the best of his knowledge, information and belief, #4 the quality of the Work is in accordance with the Contract Docu- ments; and that the Contractor is entitled to payment of the AMOUNT 3,800 CERTIFIED. 293 TOTALS , Net change by Change Orders AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT• APRIL 1978 EDITION ,• AIA® • 0 1978 The present status of the account for this Contract is as follows: ORIGINAL CONTRACT SUM ....................... $ 988,700.00 Net change by Change Orders ...... .... ......... $ 40,126.00 CONTRACT SUM TO DATE ... , , , , , , , , $ 11028,826.00 TOTAL COMPLETED & STORED TO DATE ...... $ 1,013,736.00 (Column G on 6703) 25, 000.00 RETAINAGE %a ......................... $ or total in Column 1 on G703 988,736.00 TOTAL EARNED LESS RETAINAGE .................. $ 923 550 10 The undersigned Contractor certifies that to the best of his knowledge, LESS PREVIOUS CERTIFICATES FOR PAYMENT ....... $ ' information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Docu- 65, ments, that all amounts have been paid by him for Work for which previous Certificates for Payment were issued and payments received CURRENT PAYMENT DUE ......................... $ from the Owner, and that current ayment shown herein is now due. RKAY G S ION CO. State of: unty o�IN C A 20 NO CO . 1$' ITE 189, MPLLS. M. 55427 Subscribed and s ' rn to before_ th' day of JAN. ,1987 3 1/7/87 a Notary Pu 'c: ate: 1Fres. My Commission xp+res: 0040 ARtCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED ... „:��" °"%;} .;-� + Y C RYt E ESOTA ty 5r: r �t OTA (Attach explanation if amount ce Fr`brn t cf Iarlloo I aQ + ES accordance with the Contract Documents, based on on-site obser-ARCHL s� 3 ' H'tN' vations and the data comprising the above application, the Architect " My Commission E..p!res C • 6. 1$92 certifies to the Owner that the Work has progressed to the point V. indicated; that to the best of his knowledge, information and belief, By: the quality of the Work is in accordance with the Contract Docu- ments; and that the Contractor is entitled to payment of the AMOUNT This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor CERTIFIED. named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT• APRIL 1978 EDITION ,• AIA® • 0 1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE,-N.W., WASHINGTON, D.C. 20006 G702—•1978 P-9 N 4 ROSEMOUNT CITY HALL COST BREAKDOWN CONTINUATION SHEET AIA DOCUMENT 6703 PACE 1 OF 3 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: Use Column l on Contracts where variable retainage for line items may apply. TO; ARCHITECT'S PROJECT NO: A B C D E F G H 1 ITEM DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED TOTAL COMPLETE. AND STORED % BALANCE TO FINISH RETAINAGE This Application No. Previous Applications TO DATE (D+E+F) (G=C) (C -G) Work in Place Stored Materials (not in D or E) GYRAL CONDITIONS 68,000 62,560 5,440 68,000 100 0 EARTHW10RK 17,500 17,150 0 17,150- 98 350 LAWNS & PLANTINGS 22,000 7,260 0 7,260 33 14,740 CONCRETE REINF 7,500 7,500 0 7,500 100 0 WIRE MESH 2,500 2,500 0 2,500 100 0 CONCRETE FODTINGS 91000 9,000 0 91000 100 0 SLAB ON GRADE 12,000 12,000 0 12,000 100 0 P/C TOPPING 1,700 1,700 0 1,700 100 0 MISC. CCW 7,000 7,000 0 7,000 100 0 EXTERIOR CONC 10,000 10,000 0 10,000 100 0 CURBS 6,500 6,500 0 6,500 100 0 PRECAST Cly 281000 28,000 0 28,000 100 0 MASONRY EKTERIOR 97,000 97,000 0 97,000 100 0 INTERIOR 17,000 17,000 0 17,000 100 0 STRUCT, JOISTS, DECK 40,000 40,000 0 40,000 100 0 MISC. METALS 6,000 6,000 0 6,000 100 0 ROOF TRUSSES 2,000 2,000 0 2,000 100 0 LUMBER 32, 000 32,000 0 32,000 100 0 MILLWORK, WOOD DOORS 12,000 10,200 1,800 12,000 100 0 DAMPPROOFING & INSULAT 2,500 2,500 0 2,500 100 0 METAL ROOF 72,000 72,000 0 72,000 100 0 2,000 1,600 400 2,000 100 0 HCLLOW NIETP,L 10,000 10,000 0 10,000 100 0 WOOD WINDOWS 12,000 12,000 0 12,000 100 0 O/H DOORS 1,000 1,000 0 1,000 100 0 COUNTER DOORS 2,500 2,500 0 2,500 100 0 KITCHEN CABTS, VANITIE3 3,500 2,450 1,050 3,500 100 0 503,200 479,420 8,690 488,110 15,090 AIA DOCUMENT G703 • CONTINUATION SHEET • APRIL 1978 EDITION • AIA® - ® 1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 G703 --1978 FIOSEMOM CITY HALL COST BREAKDOWN CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Contractor's signed Certification is attached. APPLICATION DATE: MIn tabulations below, amounts are stated to the nearest dollar. PERIOD FROM; :7 Use Column I on Contracts where variable retainage for line items may apply. TO; ARCHITECT'S PROJECT NO: A 8 C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED TOTAL COMPLETED AND STORED % BALANCE RETAINAGE This Application No. VALUE Previous Applications TO DATE ID+E+F) (G+C) TO FINISH IC -G) Work in Place Stored Materials (not in D or E) FINISH HAR WAM 21,000 16,800 ' 4,200 21,000 100 0 STOREF'ROW, GLASS 44,000 43,120 880 44,000 100 0 GYPBD, LATH, PIASTER 95,000 94,050 950 95,000 100 0 TUZ WORK 23,000 19,550 3,450 23,000 100 0 ACOOUSTICAL 5,000 3,750 1,250 5,000 100 0 RESILIENT FLRG 2,000 2,000 2,000 100 0 PAINT & VINYL W/00VER 16,000 10,400 5,600 16,000 100 0 SPECIALITIES 19,000 17,100 1,900 19,000 100 0 CARPET 15,000 9,750 5,250 15,000 100 0 ELEVATOR 26,000 25,740 260 26,000 100 0 PLUMBING 28,500 27,075 1,425 28,500 100 0 746,755 35,855 ?82,610 15,090 AIA DOCUMENT G703 * CONTINUATION SHEET * APRIL 1978 EDITION * AIA® * 8 1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 2WO6 6703 -1978 ROSEMOUNT CITY HALL COST BREAKDOWN CONTINUATIIQN SHEET AIA DOCUMENT 6703 PAGE 3 OF 3 PAGES - AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Contractor's si8sted Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: Use Column I on Contracts where variable retainage for line items may apply. TO: ARCHITECT'S PROJECT NO: A g C D E F G H ITEM QESCRIPTION OF WORK SCHEDULED WORK COMPLETED TOTAL COMPLETEThis AND STORED % BALANCE RETAINAGE Application No VALUE Previous Applications TO DATE (D+E+F) (G+C) TO FINISH (C—G) Work in Place Stored Materials (not in D or E) HW— 74,500 73.010 1,490 74,500 100 0 FII+1E PRUrTBCTION 14,500 14,210 290 14,500 100 0 EUIC'1MCAL 102,000 102,000 0 1021000 100 0 C.O. #1 5,236 5,236 0 5,236 100 0 C.O. #2 1,597 1,597 0 1,597 100 0 C.O. #3 3,200 3,200 0 3,200 100 0 C.O. #4 3,800 3,800 0 3,800 100 0 C.O. #5 26,293 22,350 3,943 26,293 100 0 1,02 972,158 41,578 ,013,736 15,090 AIA DOCUMEM' G703 0 CONTINUATION SHEET 0 APRIL 1978 EDITION 0 AIAe 0 0 1978 GM -1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D,C. 20006