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Home My WebLink About4.g. Request for Payment #3, Lift Station #1 Renovation (Final Payment)APPLICATION AND CERTIFICATE FOR .PAYMENT ArA DOCUMENT C702--- •'...: , = �: -PACT 'ONE. Of : PAGES PROJECT: City of Rosemount ARCHITECT: City Contract 1987-01 e 1. (7 PIEn (name, address) 2875 — 145th St. W. Lift Station #1 Renovations Rosemount, MN 55068 ARCHITECT'S PROJECT NO: Our Job No. 284 TO (Owner) Attn: Richard Hefti CONTRACTOR: [� CONTRACT FOR. APPLICATION DATE: Wit --23; 1987 APPLICATION NO: 3 — FINAL A')TN: PERIOD FROM: TO CHANGE ORDER SUMMARY Application is made for Payment, as shown below, in connection with the Contract Continuation Sheet,AtA Document G702A, is attached. Change Orders approved ADDITIONS S DEDUCTIONS S The present status of the account for this Contract is as follows: TOTALS Net change br Change Orders S iState of: County of: The undersigned Contractor certifies that the Work covered by this Appti- cation for Payment has been cumpieted 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 ORIGINAL CONTRACT SUM .S 44, 219.00 Net change by Change Orders .........S` CONTRACT SUM TO DATE .........S 442-H - - TOTAL COMPLETED & STORED TO DATE ........ S �" (Column G on G702A) RETAINAGE 0 .......................... A: or as noted in Column I on C702A w_ -�� inn TOTAL EARNED LESS RETAINAGE .......... 4T"' LESS PREvioUS CERTIFICATES FOR PAYMENT ........S 35, 750.00 CURRENT PAYMENT DUE .... ............ . S .8,459—GO— g,"T_; F' , uo the Owner, and that the current payment shown herein is now due. Contractor: PIPECO CONTRACTING, INC. Subscribed and sworn to before me this day of '19 Notary Public. My Commission expires: By: John A. Healy, III Gen. MCI. Date: 9-21-87 In accordancewith the Contract and this Application for Payment the Contractor is entitled to payment in the amount shown above. ❑ OWNER 0 ARCHITECT Architect :�u L G.c('�� (Z (.3-67 Q CONTRACTOR fly: 0 thn 6.4111.4.1h. nut n.9;t,h.ihlt , it .% p.ry.dthr tinly its ►ht• payer ttann•tl hi -rein and its i:ipance. p.tyinew rnd acceptanre are widttttrt preirrrliCt� tit any rit:lth to du• ownt•r ser (•nnlr.0 test und,•r tht•:c r nntr.rc I. • 1G\ 17t CUMINI 1.:02 .W14!1..titIN AND t1Y.111ICA I I(IR i'•\11t1-1t • .•.tAR(Ii 19711U1110N . AIA+' in previous months by Owner — - TOTAL Subsequent ChangeOrders Number Approved (date) TOTALS Net change br Change Orders S iState of: County of: The undersigned Contractor certifies that the Work covered by this Appti- cation for Payment has been cumpieted 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 ORIGINAL CONTRACT SUM .S 44, 219.00 Net change by Change Orders .........S` CONTRACT SUM TO DATE .........S 442-H - - TOTAL COMPLETED & STORED TO DATE ........ S �" (Column G on G702A) RETAINAGE 0 .......................... A: or as noted in Column I on C702A w_ -�� inn TOTAL EARNED LESS RETAINAGE .......... 4T"' LESS PREvioUS CERTIFICATES FOR PAYMENT ........S 35, 750.00 CURRENT PAYMENT DUE .... ............ . S .8,459—GO— g,"T_; F' , uo the Owner, and that the current payment shown herein is now due. Contractor: PIPECO CONTRACTING, INC. Subscribed and sworn to before me this day of '19 Notary Public. My Commission expires: By: John A. Healy, III Gen. MCI. Date: 9-21-87 In accordancewith the Contract and this Application for Payment the Contractor is entitled to payment in the amount shown above. ❑ OWNER 0 ARCHITECT Architect :�u L G.c('�� (Z (.3-67 Q CONTRACTOR fly: 0 thn 6.4111.4.1h. nut n.9;t,h.ihlt , it .% p.ry.dthr tinly its ►ht• payer ttann•tl hi -rein and its i:ipance. p.tyinew rnd acceptanre are widttttrt preirrrliCt� tit any rit:lth to du• ownt•r ser (•nnlr.0 test und,•r tht•:c r nntr.rc I. • 1G\ 17t CUMINI 1.:02 .W14!1..titIN AND t1Y.111ICA I I(IR i'•\11t1-1t • .•.tAR(Ii 19711U1110N . AIA+' C] • CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 3 — FINAL Cotitractor's signed Certification is attached. APPLICATION DATE: September 21, 1987 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: AIA DOCUMENT G703 • CONTINUATION SHEET • APRIL 1978 EDITION • AIM • m 1978 THE AMERICAN INSTITUTE Of ARCHITECTS, 1735 NEW YORK AVE.. N.W., WASHINGTON, D.C. 20006 G703 —19n e C D E F G H 1 ITEM DESCRIPTION Of WORK SCHEDULED WORK COMPLETED TOTAL COMPLETE AND STORED % TO FINIS O RETAINAGE This Application No. VALUE Previous Applications TO DATE (O+E+n (G+C) — C) ICCI Work in Place Stored Materials • foot in D or E) 1 Bonds & Insurance 2,390 2,390 2,390 100 2 Electric work 6,600 6,270 6,600 100 3 Saw Cutting 1,000 1,000 1,000 100 4 Demolition & Removal 8,000 8,000 8,000 100 5 Temporary Pumping 4,200 4,200 .4,200 100 6 Pump Installation 21,029 19,978 21,029 100 7 Clean & Paint 1,000 0 1,000 100 i Totals 44,219 41,838 44,219 100 07 AIA DOCUMENT G703 • CONTINUATION SHEET • APRIL 1978 EDITION • AIM • m 1978 THE AMERICAN INSTITUTE Of ARCHITECTS, 1735 NEW YORK AVE.. N.W., WASHINGTON, D.C. 20006 G703 —19n - S1.Paul,Minn RECEIPT AND WAIVER OF MECHANICS' LIEN RIGHTS�� 1 N. B.—It is important that the following directions be closely followed as otherwise the receipt WILL NOT BE ACCEPTED. )i. This is a LEGAL INSTRUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. If payment is not in full to date, so state. SHOW UNPAID BALANCE, and strike out last three lines. 4. A receipt similar to this or legal waiver of lien rights will be required for all plumbing, heating and plaster- ing materials. etc. 5. NO ERASURES OR ALTERATIONS MUST BE MADE. November 30 19..87....... full (Date) The undersigned acknowledges having receivedhpayment of ..... Nine teen... tllQusld-_one _hundred-,.,,-,-, P wenty,-nine... x..$ 1100.-_--------- -------------------- -.--- LL.IR , 4.19.,12.9—aa ....... (Amount Paid) From PipeCo ContracaiT]3.�....Inc........ ....................in full paymvi?t of (Name of Payor) all ........Purchase and rental of .........P................ ............................................................................................................................. (Kind of Material or Labor) by the undersigned delivered or furnished to (or performed at)........................................................ ..................... -- City.of Rosemount, Lift Stations... RoseiloUnt.....MN. ........................ ........................ ........_ ............................................................._..........................•..................................... ............................... ............................................ ................ ..... .............. _ (Street Address or Legal Description) and for value received hereby waives all rights which, may have been acquired by the undersi¢ned to file mechanie's lien against said premises for labor, skill or material furnished to said premises prior to the date hereof. WALDOR PUMP & EQU PMENT COMPANY PLUMBING, HEATING and PLASTERING .......................... ....... ..............---•........ _...............------......... contractors must sign statement on reverse 8 . ....... .. ............................... hereof. V ...................................................... ......... (Title) .4ddress........ 9..700... HIXTI] ldt..Ave......Sty.,....................... Minneapolis, MN 55431 RECEIPT AND WAIVER OF MECHANICS' LIEN RIGHTS Syg"'CQy,1 Minn N. B.—It is important that the following directions be closely followed as otherwise the receipt WILL NOT BE ACCEPTS 1. This is a LEGAL INSTRUMENT and must be executed accordingly by officers of corporations and by partners in co -partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. If payment is not in full to date, so state, SHOW UNPAID BALANCE and strike out last three linea. d. A receipt similar to this or legal waiver of lien rights will be required dor all plumbing, heating and plaster- in etc. 5. IvO ERASURES OR ALTERATIONS MUST BE MADE. ........... NQYIk?7... Q ............................................... 19..8.7 ..... full (Date) The undersigned acknowledges having recelvednpayment of ..,FOur thousand six hundred and no/100 ---- ------------ .DOLL.4RS, 4, 60Q. QQ .......... ........ ...... ......... .... ...................={ ) (Amount Paid) From,--•...............................P.ipeCO..ContraCting.,....Inc....-"-.....---.....................---............................................in full payment of (Name of Payor) electrical work all ....................................... ...... ............... (Bind of Material or Labor) by the undersigned delivered or furnished to (or performed at) ............................... ......................... ..................... City of Rosemount, Lift Stations, Rosemount, _MN ..............................".........".....•................---"-----.....-""----"----•""--.----••....................................................................................................................._.................. (Street Address or Legal Description) and for value received hereby waives all rights which may have been acquired by the undersi,¢ned to f.le mechanic's lien against said premises for labor, skill or material furnished to said premises prior to the date hereof. PLUMBING, HEATING and PLASTERING 'IDEAL'"" "'"'"" COMPANY""' " contractors must sign statement on reversey.... ,.fix....... -�! ................. hereof. Roger Strantz President ..................................... ""-............................................._............_......... (Title) .address.... 22.7.5.."McI{night... Road ..................................... North St. Paul, MN 55109