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APPLICATION AND CERTIFICATE FOR PAYMENT
<br />AIA DOCUMENT G702
<br />PAGE ONE OF TWO PAGES
<br />TO: City of Ramsey
<br />CUSTOMER PROJECT:
<br />APPLICATION NO:
<br />7
<br />Distribution to:
<br />(OWNER) 7550 Sunwood Drive NW
<br />Water Tower No.3
<br />CB &I NO.
<br />37147815
<br />TOTALS
<br />OWNER
<br />,Ramsey, MN 55303
<br />Project No.08 -21
<br />PERIOD TO:
<br />01/29/10
<br />ENGINEER
<br />CONTRACTOR
<br />FROM (CONTRACTOR):
<br />VIA (ENGINEER):
<br />ENGINEER'S
<br />OTHER
<br />CB &I Inc. - Steel Plate Structures
<br />Progressive Consulting Engineers, Inc.
<br />PROJECT NO:
<br />Project No. 08015
<br />9550 Hickman Road Clive, IA 50325 -5316
<br />CONTRACT FOR:
<br />6120 Earle Brown Drive, Suite 629
<br />CONTRACT DATE:
<br />07/09/09
<br />2MMG HP / 152' TCL
<br />Minneapolis, MN 55430
<br />16600 St. Francis Blvd., Unit #2
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />CHANGE ORDER SUMMARY
<br />Change Orders approved in
<br />previous months by Owner
<br />TOTAL
<br />ADDITIONS
<br />22,877.00
<br />22,877.00
<br />DEDUCTIONS
<br />0.00
<br />Approved this Application
<br />Number
<br />Date Approved
<br />TOTALS
<br />0.00
<br />0.00
<br />Net change by Change Orders
<br />22,877.00
<br />The undersigned Contractor certifies that to the best of the Contractor's knowledge,
<br />information and belief that the Work covered by this Aplication for Payment has been
<br />completed in accordance with Contract Documents, that all amounts have been
<br />paid by the Contractor for Work 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 />CONTRACTOR: CB &I Inc. - Steel Plate Structures
<br />Application is made for Payment, as shown below, in connection with the Contract.
<br />Continuation Sheet, AIA Document G703, is attached.
<br />1. ORIGINAL CONTRACT SUM $3,188,400.00
<br />2. Net change by Change Orders $22,877.00
<br />3. CONTRACT SUM TO DATE (Line 1+ /- 2) $3,211,277.00
<br />4. TOTAL COMPLETED & STORED TO DATE (Col G on G703) $2,246,580.22
<br />5. RETAINAGE:
<br />a. 5% of Completed Work
<br />(Col D + E on G703)
<br />b. 0% of Stored Material
<br />Col F on G703)
<br />Total Retainage (Line Sa + 5b or
<br />(Total in Col I of G703)
<br />6. TOTAL EARNED LESS RETAINAGE
<br />(Line 4 less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR
<br />PAYMENT (Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE
<br />9. BALANCE TO FINISH, PLUS RETAINAGE
<br />$112,329.01
<br />0.00
<br />$112,329.01
<br />$2,134,251.21
<br />$1,948,313.05
<br />$185,938.16
<br />$1,077,025.79
<br />(Line 3 less Line 6)
<br />State of: IOWA County of: POLK
<br />Subscribed and sworn to before me this 27th day of January, 2010. wim
<br />ZENZ ber 713886 Date: January 27, 2010 Notary Publicn Fatpir A/R Adminis at My Commission expires: Dec. 03, 2oto 20
<br />ENGINEER'S CERTIFICATE FOR PAYMENT
<br />In accordance with the Contract Documents, based on on -site observations and the
<br />data comprising the above appplication, the Engineer certifies to the Owner that to the
<br />best of the Engineer's knowledge, Information and belief the Work has progressed as
<br />Indicated, the quality of the Work Is In accordance with the Contract Documents, and
<br />the Contractor is entitled to payment of the AMOUNT CERTIFIED.
<br />AMOUNT CERTIFIED
<br />(Attach explanation if amount certified differs from the amount applied for.)
<br />ENGINEER: Progressive Consulting Engineers, Inc.
<br />By:_ —'C- _ ? Date: 2 G
<br />OWNER: Of say
<br />By: /0 /G
<br />This Certificate Is not negotiable. The AMOUNT CERTIFIED is payable onlyto the
<br />Contractor named herein. Issuance, payment and acceptance of payment are without
<br />prejudice to any rights of the Owner or Contractor under t his Contract.
<br />AIA DOCUMENT 6702 APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AIA 0 1992 G702 -1992
<br />THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20008
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