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<br />AlA DOCUMENT G702 PAGE ONE OF TWO PAGES <br /> . - <br />APPLICATION NO: 11 Distribution to <br />CB&I NO. 37147815 ~ OWNER <br />PERIOD TO: OS/21/10 ENGINEER <br /> CONTRACTOR <br />ENGINEER'S OTHER <br />PROJECT NO: Project No. 08015 <br />CONTRACT DATE: 07/09/09 <br /> <br />CUSTOMER PROJECT: <br />Water Tower NO.3 <br />Project NO.08-21 <br /> <br />APPLICATION AND CERTIFICATE FOR PAYMENT <br />TO: <br />(OWNER) <br /> <br />City of Ramsey <br />7550 Sunwood Drive NW <br />Ramsey, MN 55303 <br /> <br />VIA (ENGINEER): <br />Progressive Consulting Engineers <br />Inc. <br />6120 Earle Brown <br />Minneapolis, MN <br /> <br />FROM (CONTRACTOR) <br />CB&llnc. - Steel Plate Structures <br />9550 Hickman Road Clive, IA 50325-5316 <br /> <br />Suite 629 <br /> <br />Drive <br />55430 <br /> <br />CONTRACT FOR: <br />2MMG HP / 152' TCl <br />16600 St. Francis Blvd. <br /> <br />Unit #2 <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br />$3, 188,400.00 <br />$23,817.00 <br /> <br />$3,212,217.00 <br />$2,599,278.00 <br /> <br />Application is made for Payment, as shown below, in connection with the Contract <br />Continuation Sheet. AlA Document G703, Is attached. <br /> <br />ORIGINAL CONTRACT SUM <br />Net change by Change Orders <br />CONTRACT SUM TO DATE (Line 1+/- 2) <br />TOTAL COMPLETED & STORED TO DATE (Col G on G703) <br />RETAINAGE: <br />a. 3% of Completed Work $77,978.34 <br />(Col D + E on G703) <br />b. 0% of Stored Material 0.00 <br /> <br />1. <br />2. <br /> <br />3. <br />4. <br />5. <br /> <br />CHANGE ORDER SUMMARY <br />Change Orders approved in ADDITIONS DEDUCTIONS <br />previous months by Owner 23,817.00 <br /> TOTAL 23,817.00 0.00 <br />Approved this Application <br />Number Date Approved <br /> TOTALS 0.00 0.00 <br />Net change by Change Orders 23,817.00 <br />-. <br /> <br />$77,978.34 <br /> <br />Col F on G703) <br />Total Retainage (Line 5a + 5b or <br />(Total in Coil of G703) <br />6. TOTAL EARNED LESS RETAINAGE <br /> <br />299.66 <br /> <br />$2.521 <br /> <br />(Line 4 less Line 5 Total) <br />LESS PREVIOUS CERTIFICATES FOR <br />Certificate) <br /> <br />7. <br /> <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 /> <br />$2,343,207.30 <br />$178,092.36 <br />$690,917.34 <br /> <br />~... GAYLA L. ZENZ <br />i l. Commission Number 713888 <br />. . My CommIssion ExpIr <br />ow December, 3 20, <br /> <br />PAYMENT (Line 6 from prior <br />CURRENT PAYMENT DUE <br /> <br />BALANCE TO FINISH, PLUS RETAINAGE <br /> <br />(Line 3 less Line 6) <br /> <br />State of: IOWA County of: POLK <br />Subscribed and sworn to before me this 7th day of June, 2010. <br />CJ I ----../ __=<) <br />Notary Public '.:F- CL~J l:_ ~. ()C!--t. I) <br /> <br />My Commission expires t Dec. 03, 2010 ( <br /> <br />8. <br />9. <br /> <br />lP/78 092,~ <br /> <br />if amount cedified differs from the amount applied for.) <br /> <br />AMOUNT CERTIFIED <br /> <br /> <br />nc. <br /> <br />Date: <br /> <br />By: Date: <br />This Certilicate is not negotiable. The AMOUNT CERTIFIED is payable only <br />Contractor named herein. Issuance, payment and acceptance of payment are without <br />prejudice to any rights of the Owner or Contractor under this Contract. <br /> <br />the <br /> <br />to <br /> <br />(Attach explanation <br /> <br /> <br />OWNER: <br /> <br />City of Ramsey <br /> <br />By: <br /> <br />CONTRACTOR: CB&llnc. - Steel Plate Structures <br />--... <br />~ <br />. ~; "\' <br />. .. . l Date: June 7, 2010 <br />. : . .~~IT ....... - <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 />AlA OOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AlA @ 1992 <br />THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, NW.. WASHINGTON. D.C. 20006 <br /> <br />