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IJ <br />! <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> <br />APPLICATION FOR PAYMENT NO. 3 <br /> <br />To: City, of Ramsey (OWNER) <br />From: Ma?ey Contnmtion. Inc. 19245 Hwy 7, Excelsior, MN 55331 (CONTRACTOR) <br />Contract: General Construction <br />Project: Minnesota Pump ~ouse No_ 3 <br />OWNER' s Contract No. ENGINEER's Project No. <br />For Work accomplished through the date of: ~ <br /> <br />1.) Original Contract Price: <br />2.) Net change by Change Orders/Wr/tten Amendments (+-) <br />3..) Current Contract Price (1 plus 2): <br />4.) Total completed and stored to date: <br />5.) Retainage (per Agreement): <br /> ~ of completed work. $ 7,71 855 <br /> 5 % of stored material: $ 91T65 <br /> Total Retainage: <br />6.) Total completed and stored to date less retainage (4-5) <br />7.) Less previous Application for Payments: <br />8.) DUE THIS APPLICATION (6-7) <br /> <br />$ 495?00 O0 <br />$ <br />$ 405:500.00 <br />$ 172724 00 <br /> <br />$ 8;631 20 <br />$ 163;992 80 <br /> <br />Accompanying Documentation: <br /> <br />CONTRACTOR'S Certification: <br /> <br />The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER <br />on account of Work done under the Contract referred to above have been applied on account to discharge <br />CONTRACTOR's legitimate obligations incurred in connection with Work covered by prior Applications <br />for Payment numbered 1 through 3_inclusive; (2) title of all Work, materials and equipment incorporated in <br />said Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of <br />payment free and clear of all Liens, security interests and encumbrances (expect such as are covered by a <br />Bond acceptable to OWNER indemnifying OWNER against any such Lien, security interest or <br />encumbrance); and (3) all Work covered by this Application for Payment is in accordance with the Contract <br />Documents and not defective. <br />Dated ~ Magney Construction, [nc (Contractor) <br /> <br /> Mark C. Mag-ney, Presi em y <br /> <br />State of f 2 ..-: ....... <br /> befote ..~,~s' _2 ,2002..~ ,~'", ':': [/AM <br />Subscribed and sworn to 2. <br /> <br />My Commission expires: .., '"~'~ ......................... <br /> <br /> THIS APPLICATION is: <br />Payment of the above AMOUNT DUE rL~x.rr~ended. <br /> <br />Dated / /-~/2c30 a Flnlton & Menk. lne (engineer) <br /> / <br /> <br />-115- <br /> <br /> <br />