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APPUCATION AND CERTIFICATE FOR PAYMENT
ASA DOCUMENT G702
PAGE GINE OF PA
co a%
TO (Owner): CITY OF ROSEMOUNT PROJECT: ROSEMOUNT CITY HALL APPLICATION NO: 10
Distribution to:
O OWNER
-4
1367 145TH STREET EAST4/1/87
PERIOD FROM: 4/ 1/ 8 7
O ARCHITECT
ROSEMOUNT , MN. 55068
jeILD TO CUU116Ii- TO: 4/30/87
E) CONTRACTOR
H
.,
MAY 2 91987
CONTRACT FOR:
ARCHITECT'S
Q
ATTENTION:
at B v'", PROJECT NO:
CONTRACT DATE:
CONTRACTO R'S APPLICATION FOR PAYMENT
Application is made for Payment, as shown below, in connection with the Contr
Continuation Sheet, AIA Document G703, is attached.
•
CHANGE ORDER SUMMARY
Change Orders approved
in previous months b
Owner
TOTAL
ADDITIONS
59 417.0
DEDUCTIONS
Approved this Month
Number Date Approved
TOTALS 59 41
Net thane by Change Orders
59, 417. 0
The undersigned Contractor certifies that to the best of his Knowieoge,
information and belief the Work covered by this Application for
Payment has been completed in accordance with the Contract Docu-
ments, that all amounts have been paid by him for Work for which
previous Certificates for Payment were issued and payments received
from the Ownet, and that current pment shown herein is now due.
'CON RACTPR: A ONSTRQCTION CO.
6_ , ,"CO. F D:,e"18, SUITE 189,
Date:—ALI(LL8 7
By.-
The
y.
The present status of the account for this Contract is as follows:
ORIGINAL CONTRACT SUM ....................... $ 988,700.00
Net change by Change Orders ..................... $ 59,417.00
CONTRACT SUM TO DATE ........................ S1,048,117.00
TOTAL COMPLETED & STORED TO DATE . , ......... $-a 4AR.,117 n n
(Column G on G703)
RETAINAGE % ......................... $- 2 5-, 0 O n
or total in Column I on G703
TOTAL EARNED LESS RETAINAGE .................. S I Q 2.1..117 - nn
LESS PREVIOUS CERTIFICATES FOR PAYMENT ....... $1 ..Q Q R , 092 _ On
CURRENT PAYMENT. DUE .................. ... . . $ 15,090.00
State of: M-(NNESO'A
MN . Subscribed- worn to be oreCejh�i7s
MPLS
Notary Publ
My Commi , ign expires: 2/6/92
County of: HE EPIN
day Of APRIL 87
ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIE ...;�:�;,,... $Iza:Ty-0.-0.
(Attach explanation amount opptieV for.)
In accordance with the Contract Documents, based on on-site obser- ARCHITE' �,:.� lY,, CCUK s
vations and the data comprising the above application, the Architect
certifies to the Owner that the Work has progressed to the point `
indicated; that to the best of his knowledge, information and belie(, By: � ate:
the quality of the Work is in accordance with the Contract Docu- This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contra
ments; and that the Contractor is entitled to payment of the AMOUNT named herein. Issuance, payment and acceptance of payment are without prejudice to
CERTIFIED. rights of the Owner or Contractor under this Contract.
0Av"rAIT 0 APRIL 1979 FOITION 0 AIAS - 9) 1979
M
At
r�
U
ROSEMOUNT CITY HALL
COST BREAKDOWN
CONTINUATION SHEET AIA DOCUMENT G703 MAGE 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 I on Contracts where variable retainage for line items may apply. TO:
ARCHITECT'S PROJECT NO:
A
8
C
D
E
F
G
H
ITEM
DESCRIPTION OF WORK
SCHEDULED
WORK COMPLETED
TOTAL COMPLETED
AND STORED
%
BALANCE
TO FINISH
RETAINAGE
This Application
No
VALUE
Previous
Applications
TO DATE
iD+E+F)
(G=C)
(C -G)
Work in Place
Stored Materials
(not in D or E)
GENERAL CONDITIONS
68,000
68,000
0
68,000
10 0
0
EAFMI ORK
17,500
17,150
350
17,500
100
0
LAWNS & PLANTINGS
22,000
7,260
14,740
22,000
10 0
0
CONCRETE REINF
7,500
7,500
0
7,500
100
0
WIRE MSH
2,500
2,500
0
2,500
100
0
CONCRETE
FOOT11dGS
9,000
91000
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. CCNC
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 CONC
28,000
28,000
0
28,000
100
0
MASONRY
EXTERIOR
97,000
97,000
0
97,000
100
0
INTERIOR
17,000
17,000
0
17,000
100
0
STRICT, JOISTS, DECK
40,000
40,000
0
40,000
10 0
0
MISC. PETALS
6,000
6,000
0
6,000
100
0
ROOF TRUSSES
2,000
2,000
0
2,000
100
0
UMER
32,000
32,000
0
32,000
100
0
MIILWORK, WOOD DOORS
12,000
12,000
0
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
CAULKMG
2,000
2,000
0
2,000
100
0
HOLLOW METAL
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
COULTER DOORS
2,500
2,500
0
2,500
100
0
KITCHEN CABTS, VANITIESS
3,500
3,500
0
3,500
100
0
503,200
488,110
15,090
503,200
0
AIA DOCUMENT G703 • CONTINUATION SHEET • APRIL 1978 EDITION • AIA'E • G 1978
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NE%V YORK AVE., NAN'_ WASHINGTON, D.C. 20006
G703 - 9978
ROSEMOUN'T CITY HALL COST BREAKDOWN
M
CONTINUATION SHEET AIA DOCUMENT G703 PACE 2 OF 3 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:
n• Contractor's signed Certification is attached. APPLICATION DATE:
Co In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM:
(714 Use Column l on Contracts where variable retainage for line items may apply. TO:
' '4 ARCHITECT'S PROJECT NO:
•
0
A
B
C
D
E
F
G
H
ITEM
DESCRIPTION OF WORK
SCHEDULED
WORK COMPLETED
TOTAL COMPLETED
AND STORED
%
BALANCE
TO FINISH
RETAINAGE
This Application
No
VALUE
Previous
Applications
TO DATE
(D+E+F)
(G=C)
(C -G)
Work in Place
Stored Materials
(not in D or E)
FINISH HARDWAM
21,000
21,000
0
21,000
100
0
STOREFRONT, GLASS
44,000
44,000
0
44,000
100
0
GYPBD, LATH, PLASTER
95,000
95,000
0
95,000
10 0
0
TILE WORK
23,000
23,000
0
23,000
100
0
ACCOUSTICAL
51000
5,000
0
5,000
100
0
RESILIENT FLRG
2,000
2,000
0
2,000
100
0
PAINT & VRM W/COVER
16,000
16,000
0
16,000
100
0
SPECIALITIES
19,000
19,000
0
19,000
100
0
CARPET
15,000
15,000
0
15,000
100
0
ELEVATOR
26,000
26,000
0
26,000
100
0
PL;UmBING
28,500
28,500
0
28,500
100
0
797,700
782,610
15,090
797,700
0
AIA DOCUMENT G703 • CONTINUATION SHEET • APRIL 1978 EDITION • AIA' • �c 1978
THE AMERICAN INSTITUTE OE ARCHITICTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 G703- 1978
ROSEMOUNT CITY HALL
regqiS C G .406�If`I
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 3 Of 3 PAGt.S
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 I on Contracts where variable retainage for line items may apply. TO:
ARCHITECT'S PROJECT NO:
A
B
C
D
E
F
G
H
I
ITEM
DESCRIPTION OF WORK
SCHEDULED
WORK COMPLETED
TOTAL COMPLETED
AND STORED
oro
BALANCE
TO FINISH
RETAINAGE
This Application
No
VALUE
Previous
Applications
TO DATE
lD+E+F►
(G=C)
(C—G)
Work in Place
Stored Materials
(not in O or E)
HVAC
74,500
74,500
0
74,500
100
0
FIRE PRCTTECTION
14,500
14,500
0
14,500
100
0
ELEC'T'RICAL
102,000
102,000
0
102,000
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
26,293
0
26,293
100
0,tn
C.O. #6
19,291
19,291
0
19,291
100
0
.o
CID
0*4
lea
w
,048,117
1,033,02
15,090
1,048,117
0
AIA DOCUMENT G703 • CONTINUATION SHEET • APRII 1978 EDITION • AIA"- • G 1978 G703 -- 1978
THE AMERICAN INS711UTE CN ARCHITECTS, 1735 NEV,' YORK AVE., N.W.. WASHINGTON, D.C. 20006
CLERK'S
FILE 1987
OZ -K laai 000 0 0001 000 z 000E 000 0- 000 9
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