Laserfiche WebLink
Change Order <br />Summary <br />Orders approved in <br />months by Owner <br />1 TOTAL <br />Additions <br />0 <br />Deductions <br />0 <br />Change <br />previous <br />Approved this Month <br />191,057.00 <br />Number . <br />Date Approved <br />1 <br />9/14/2011 <br />TOTALS <br />191,057.00 <br />0,00 <br />Net than le by Change Orders 191,057.00 <br />Application and Certificate for Payment <br />To (Owner): City of Ramsey <br />7550 Sunwood Drive NW <br />Ramsey, MN 55303 <br />From (Contractor): Knutson Construction <br />5500 Wayzata Blvd, Suite 300 <br />Minneapolis, MN 55416 <br />Contract For: <br />CONT72ACTOR'S APPLICATION FOR PAYMENT <br />The undeisigned Contractor certifies that to the best of the Contractor's knowledge, <br />informatijn and belief the Work covered by this Application for Payment has been <br />completed in accordance with the Contract Documents, that all amounts have been <br />paid by the Contractor for Work for which previow . ificates for Payment were <br />issued and payments received from th e• er current payment shown <br />herein is i ow due. <br />Contractor: <br />By: <br />Date: /0 / <br />AI� otidiITECT'S CERTIFICATE FOR PAYMENT <br />accordiutce with the Contract Documents, based on on -site observations and the <br />data comprising the above application, the Architect certifies to the Owncr that to the <br />best of the Architect's knowledge, information and belief the Work has progressed as <br />indicated,!the quality of the Work is an accordance with the Contract Documents, and <br />the Contractor is entitled to payment of the AMOUNT CERTIFIED. <br />APPI;ICATION AND CERTIFICATE FOR PAYMENT <br />Revi:,ed July, 2005 <br />Project: Ramsey Municipal Parking Facility - Phase II <br />Subscribed and worn to before me on this <br />Notary Public: <br />My Commission exp e . 1 ) 3) <br />Amount Certified <br />By: <br />1 <br />Page One of <br />Application No: <br />Period To: <br />Via (Architect): LSA Design Inc Architect's <br />219 North Second Street, Suite 302 Project No: <br />Minneapolis, MN 55401 <br />Contract Date: 8 /25/2011 <br />Application is made for Payment, as shown below, in connection with the Contract, <br />Continuation Sheet, attached. <br />1. Original Contract Sum S 2,734,000.00 <br />2. Net change by Change Order S 191,057.00 <br />3. Contract Sum To Date (Line 1 f 2) S 2,925,057.00 <br />4. Total Completed & Stored To Date S 601,230.00 <br />(Column G on G703) <br />5. Retainage: <br />a. _% of Completed Work $ 30,061.00 <br />(Column D+ E on 0703) <br />b. _ % of Stored Material $ 0 <br />(Column F on G703) <br />Total Retainage (Line 5a + 5b or <br />Total in Column I of 0703) <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 />(Line 3 less Line 6) <br />$ 30,061.00 <br />S 571,169.00 <br />State of: Minnesota County of: Hennepin <br />II <br />S <br />S <br />S <br />Pages <br />1 Distribution to: <br />E �j Owner <br />f <br />9/30/2011 '�i Architect <br />la Contractor <br />10 - 12 <br />0.00 <br />571,169.00 <br />2,353,888.00 <br />70 I <br />• <br />AMY JOY JANSEN <br />Notary Public-Minnesota <br />my (.ommiss/on txplres Jan :it, 2015 <br />• ) �_ <br />(Attach explanation if amount certified differs from the amount applied for.) <br />Architect: <br />Date: 7 2'y 1/ <br />This Certificate is not negotiable. e AMOUNT CERTIFIED is payable only to the <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 />. 00 <br />Tab 141 <br />