Agenda - Council - 08/24/2010 - Laserfiche WebLink

Home

APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF TWO PAGES TO: City of Ramsey CUSTOMER PROJECT: APPLICATION NO: 13 Distribution to: (OWNER) 7550 Sunwood Drive NW Water Tower No.3 CB&I NO. 37147815 0.00 1 0.00 OWNER Ramsey, MN 55303 Project No.08-21 PERIOD TO: 07/30/10 ENGINEER CONTRACTOR FROM (CONTRACTOR): VIA (ENGINEER): ENGINEER'S OTHER CB&I Inc. - Steel Plate Structures Progressive Consulting Engineers, PROJECT NO: Project No. 08015 9550 Hickman Road Clive, IA 50325-5316 Inc. CONTRACT FOR: 6120 Earle Brown Drive, Suite 629 CONTRACT DATE: 07/09/09 2MMG HP / 152' TCL Minneapolis, MN 55430 16600 St. Francis Blvd., Unit#2 CONTRACTOR'S APPLICATION FOR PAYMENT CHANGE ORDER SUMMARY Change Orders approved in previous months by Owner TOTAL ADDITIONS 23,817.00 23, 817.00 DEDUCTIONS 0.00 Approved this Application Number I Date Approved TOTALS 0.00 1 0.00 Net change by Change Orders 1 23,817.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief that the Work covered by this Aplication for Payment has been completed in accordance with Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. CONTRACTOR: CB&I Inc. - Steel Plate Structures I� �r Date: AIR Adminiskratclr Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. . ORIGINAL CONTRACT SUM $3,188,400.00 $23,817.00 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line 1+/- 2) 4. TOTAL COMPLETED & STORED TO DATE (Col G on G703) 5. RETAINAGE: a. 3% of Completed Work (Col D + E on G703) b. 0% of Stored Material Col F on G703) Total Retainage (Line 5a + 5b or (Total in Col I of G703) 6. TOTAL EARNED LESS RETAINAGE (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, PLUS RETAINAGE $88,492.14 1=1 $3,212,217.00 $2,949,738.00 $88,492.14 $2,861,245.86 $2,606,286.21 $254,959.65 $350,971.14 (Line 3 less Line 6) State of: IOWA County of: POLK Subscribed ands rn to before me this 3rd day of Augut, 200110. i QAYU L. ZENZ C� Commission Number 713888 August 3, 2010 Notary Public �� My Commission EftpireS�, My Commission expires: Dec. 03, 2010 39t s ow December, 320 ENGINEER'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising the above appplication, the Engineer certifies to the Owner that to the best of the Engineers knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED 1$ 2 5� 1 9 5 ?. 6-5 (Attach explanation if amount certified differs from the amount applied for.) ENGINEER: Progressive CWsulting Engineers, Inc. By: Date: OWNER: City of Ramsey By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AIA @ 1992 G702-1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVENUE. N W. WASHINGTON O.C. 90005