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<br />PAGE ONE OF 'tWO PAGES <br /> <br />Distribution to: <br /> <br /> <br />~~ <br /> <br />5 <br />37147815 <br />11/28109 <br /> <br />AlA DOCUMENT G702 <br />APPLlCA TIONNO: <br />CB&I NO. <br />PERIOD TO: <br /> <br />APPLICATION AND CERTIFICATE FOR PAYMENT <br />CUSTOMER PROJECT: <br />Water Tower No.3 <br />Project NO.08-21 <br /> <br />NW <br /> <br />City of Ramsey <br />7550 Sunwood Drive <br />Ramsey, MN 55303 <br /> <br />TO: <br />(OWNER) <br /> <br />ENGINEER <br />CONTRACTOR <br />OTHER <br /> <br />Project No. 08015 <br /> <br />07109109 <br /> <br />ENGINEER'S <br />PROJECT NO: <br /> <br />CONTRACT DATE: <br /> <br />VIA (ENGINEER): <br />Progressive Consulting Engineers. <br />Inc. <br />6120 Earle Brown Drive, Suite 629 <br />Minneapolis, MN 55430 <br /> <br />FROM (CONTRACTOR): <br />CB&llnc. - Steel Plate Structures <br />9550 Hickman Road Clive, IA 50325-5316 <br />CONTRACT FOR: <br />2MMG HP J 152' TCl <br />16600 Sf. Francis Blvd., Unit #2 <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br />$3,188,400.00 <br />$22,877.00 <br />$3.211,277.00 <br />$1,808,857 .90 <br /> <br />in connection with the Contract. <br /> <br />Application is made for Payment, as shown below, <br />ContInuation Sheet, AlA Document G703, is attached. <br />1. ORlGlNAL CONTRACT SUM <br />Z. Net change by Change Orders <br />3, CONTRACT SUM TO DATE (tine 1+/- 2) <br />4, TOTAl COMPLETED & STORED TO DATE <br />5. RETAlNAGE: <br /> <br />0.00 <br /> $90,442.90 <br /> $1,718,415.00 <br /> $1,385,398.68 <br /> $333,016.32 <br /> $1,492,862.00 <br />- <br />- <br />~ GAYlA L. ZENZ <br />~ 'J ~ Commiasion Number 713888 <br />. ~ -.. My Commission J?cpires~ ! <br /> <br />L 5% of Completed Work <br />(Co! 0 + E on G703) <br />b. 0% of Stored Material <br />Co! F on G703) <br />Total Retalnage (Une Sa + 5b or <br />(Total In Coil of G703) <br />Ii. TOTAl EARNED lESS RETAlNAGE <br />(Une 4 less Une 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (line Ii from prior Certificate) <br />8. CURRENT PAYMENT DUE <br />9. BAlANCE TO fINISH, PLUS RETAINAGE <br /> <br />(Line 3 less Une Ii) <br /> <br />Stale of: IOWA County of: POLK <br />Subscribed and sworn to before me this 2nd day of December, 2009. <br /> <br />_ 0.. ~O-(--(I <br />03,2010 6 ~ <br /> <br />$90,442.90 <br /> <br />(CoI G on G703) <br /> <br />ADDITIONS DEDUCTIONS <br />22,877.00 <br />22,877.00 0.00 <br />0.00 0.00 <br />22,877.00 <br /> <br />The undersigned Conlractor certifIeS that to the best of the Contractol's knowledge, <br />infonnalion and belief that the Work covered by this Aplication for Payment has been <br />completed in accordance with Contract Documents, that al\ amounts have been <br />paid by the Contractor for Worlt for which previous Certificates for Payment were <br />issued and payments received from the Owner, and that current payment shown <br />herein is now due. <br /> <br /> <br />December 2, 2009 <br /> <br />CB&lloc. - Steel Plate Structures <br /> <br />Date: <br /> <br /> <br />CONTRACTOR: <br /> <br /> <br />G102.1I92 <br /> <br /> <br />AMOUNT CERTIFIED <br />(Attach explanation if amount certified differs from the amount applied for.) <br /> rogressive Consulting Engi ers, Ine. ~ <br /> ' 7, . <br />By: .r. Date: . L . <br />OWNER: ~:/ <br />By: ~ .. Date: /;P <br />This Celtificate is not negotiable. The AMOUNT CERTIFIED is payable only to tIJe <br />ConIrador named herein. Issuance. payment and acceplance of payment are without <br />prejudice 10 any rights of tIJe Owner or Contractor under this Contract <br /> <br />ENGINEER'S CERTIFICATE FOR PAYMENT <br />In accordance with tIJe Conlract Docunents. based on on-site observations and the <br />data comprising tIJe above apppIicatian. /he Engineer cerIifies to tIJe Owner that 10 /he <br />besl of the Engineets knowledge. informalion and belief the Work has progressed as <br />indicated, the quality eX the Work is in aa::ordance with the Con1ract Documents. and <br />the Contractor is enIilIed to payment eX lhe AMOUNT CERTIFIED. <br /> <br />AlA OOCUMENT (;102 APPUCATIOIlANO CER1lFICATE FOR PAYIlEHT &lAY 1983 EOITlON AlA 4ll tUll2 <br />THE AMER~ INSTITUTE OF ARCHITECTS, .t1~NEWYORKAVENUE. N.W.. WASHlHGTOH. D.C. 21!006 <br />