HomeMy WebLinkAbout4.d. Application #2 - Lift Station #1APPLICATION AND CERTIFICATE FOR
PAYMENT AIA DOCUMENT 0702 ` •PAGE ONE OF ? •PAGES
PROJECT:
ARCHITECT:
CURRENT PAYMENT DUE .........................
(name, address)
City of Rosemount
City Contract 1987-01
2875 - 145th St. W.
ARCHITECT'S PROJECT NO:
Lift Station #1 Renovations
Rosemount, M 55068
Approved
Our Job No. 284
TO (Owner)
CONTRACTOR:
Attn: Richard Heft
CONTRACT FOR:
APPLICATION DATE: July 29,
1987 APPLICATION NO: 2
I
ATTN: PERIOD FROM: TO
CHANGE ORDER SUMMARY Application is made for Payment, as shown below, in connection with the Contract.
Continuation Sheet,AIA Document G702A, is attached.
Change Orders approved ADDITIONS $ DEDUCTIONS S
in prenotts months by The. present status of the account for this Contract is as follows:
TOTALS
Net change by Change Orders $
State of: County of:
The undersigned Contractor certifies that the Work covered by this Appli-
cation for Payment has been completed in accordance with the Contract
Documents, that all amounts have been paid by him for Work for which
previous Certificates for Payment were issued and payments received from
the Owner, ^and that the current payment shown herein is now due.
Contractor. ; ipeC Co t- act ' g Inc.
ORIGINAL CONTRACT SUM ...................... S 44,219 z-00
Net change by Change Orden ...................S 0
CONTRACT SUM TO DATE .................. S_44,219.00
TOTAL COMPLETED & STORED TO DATE .........
(Column G on G702A)
RETAINAGE 5 % ................. S
or as noted in Column I on G702A
TOTAL EARNED LESS RETAINAGE ........ ........S'�`'� 35�75�
LESS PREVIOUS CEmncATFS FOR PAYMENT
........ S
7,630-00
CURRENT PAYMENT DUE .........................
Owner—
^''�)
TOTAL
Subsequent ChangeOrdets
Number
Approved
(date)
TOTALS
Net change by Change Orders $
State of: County of:
The undersigned Contractor certifies that the Work covered by this Appli-
cation for Payment has been completed in accordance with the Contract
Documents, that all amounts have been paid by him for Work for which
previous Certificates for Payment were issued and payments received from
the Owner, ^and that the current payment shown herein is now due.
Contractor. ; ipeC Co t- act ' g Inc.
ORIGINAL CONTRACT SUM ...................... S 44,219 z-00
Net change by Change Orden ...................S 0
CONTRACT SUM TO DATE .................. S_44,219.00
TOTAL COMPLETED & STORED TO DATE .........
(Column G on G702A)
RETAINAGE 5 % ................. S
or as noted in Column I on G702A
TOTAL EARNED LESS RETAINAGE ........ ........S'�`'� 35�75�
LESS PREVIOUS CEmncATFS FOR PAYMENT
........ S
7,630-00
CURRENT PAYMENT DUE .........................
$
^''�)
%v^ t -'f�•
Subscribed and swam to before me this day of '19
Notary Public:
My Commission expires:
r h1 accordance tath th ontract i;d this Ap�pli tion for Payment the Cuntractor is entitled to payment in the amount shown above. ❑ OWNER
❑ ARCHITECT
Y �' 7 �.- ❑ CONTRACTOR
illi. Certatt ate r, not negotral)14% It r, payable only to the payed named heroin and ih i:wancc, paynto.nt and acceptanre are without preµuiice Its any right-, rat the Owner of C•nnlrar for unr).•r th,-:: r nnlrai
VA 1)tH.UA11NI (.:U2 if ;.I itlra ,SNI) t IKtlttt;tll I( JR I'M \itNI • MARC1111171 11Itil()N . AIA•■)
i
CONTINUATION SHEET AIA DOCUMENT 0703 PAGE 2 OF 2 PAGES
AIA Document 0702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 2
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
ITEM
DESCRIPTION OF WORK
SCHEDULED
WORK COMPLETED
TOTAL COMPLETED
AND STORED
%
BALANCE
RETAINAGE
This Application
No.
VALUE
Previous
TO DATE
{G -i -Cl
TO FINISH
IC—Gi
Stored Materials
Applications
Work in Place
(not in D or E)
(D+E+F)
1
Bonds &'Insurance
2,390
2,390
2,390
100
2
Electric Work
6,600
1;980
6,270
95
3
Saw Cutting
1,000
900
1,000
100
4
Demolition & Removal
8,000
1,600
8,000
100
5
Temporary Pumping
4,200
0
4,200
100
6
Ptanp Installation
21,029
1,161
4-
93'
7
Clean & Paint
1,000
0
0
0
341=8$
Totals to Date
44,219
8,031
AIA DOCUMENT 6793 • CONTINUATION SHEET • APRIL 1978 EDITION • AIAO • m 1978
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006
6703-1978
�. 1