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LL <br />m <br />m <br />Q) <br />0• <br />rn <br />M <br />0) <br />0)9 <br />LL <br />N <br />N <br />r` <br />a <br />' <br />fl_ <br />O <br />c <br />w <br />c <br />dU <br />c3 <br />APPLICATION FOR PAYMENT <br />r r <br />Application No <br />Project: City of Ramsey Public Works <br />Application Date: 10/28/20 <br />O <br />co <br />O <br />O <br />N <br />CD <br />CD <br />T <br />O <br />z <br />U <br />a) <br />0 <br />Contract Date: <br />195200180-022105 <br />Commitment: <br />0 <br />E P <br />C <br />u I� `_ 0 <br />ass) <br />c� o <br />ro <br />.c <br />�30.) <br />LE U U <br />o C L U <br />�•a 3 m <br />U 0-0 <br />a @ Y C <br />v c O <br />3a�0 <br />o. `o <br />E U 0 <br />U U <br />O E <br />c c E <br />.113U� <br />9 ma <br />U N m <br />co @ +t <br />rr.oa) <br />U <br />o c a N <br />n c c <br />N <br />w 0a E <br />.c <br />W N @ <br />N U C a <br />a o• o m <br />5 o. <br />< E v <br />U @ E. <br />m . m 3 <br />tea-0). <br />U8acim.c <br />aaiY EL c <br />0)O U4O O <br />0 <br />OaNiN <br />CD a) <br />a U C <br />c �� <br />Lmoa)m <br />I- .o 0 0 a <br />O <br />O <br />O <br />O <br />N <br />N <br />CT AMOUNT <br />1. ORIGINAL CONT <br />0 <br />0 <br />O <br />64 <br />2. NET CHANGE BY CHANGE ORDERS <br />0 <br />0 <br />O <br />co <br />69. <br />N <br />N <br />3. CONTRACT SUM TO DATE <br />0) <br />@ <br />0 <br />w <br />0 <br />0 <br />0 <br />W <br />0 <br />F- <br />0) <br />0 <br />Z <br />0 <br />W <br />W <br />J <br />d <br />2 <br />0 c7 <br />0 <br />J c <br />O U <br />� v <br />5. RETAINAGE <br />0 <br />C <br />0 <br />0 <br />0 <br />O <br />5.00% of Completed Work <br />0 <br />coo <br />a <br />Subscribed and sworn to before me this <br />(Columns D + E) <br />5.00% of Stored Materials <br />1 <br />N <br />E <br />O <br />0 <br />-aU c oW <br />W U1 <br />0 f"caU RI <br />Y'E0 <br />U nP�a) 00 co <br />o a .2iD-. co <br />LT_ 0r=-N <br />20.0Y O E-a <br />N LLJ 0iS c oQ W ..` c <br />U U >L LT_E.. <br />aa)) w R t.: -2. — 2cT <br />c I" L�E@� W 2 @ <br />No W rn� f 0 2a <br />U 000Z'E fmyalt'a•c <br />ooE = a8 Ea) <br />-F.; o <br />°^ <br />f <br />QCN <br />G<c U N < <Q <br />O <br />O <br />Total Retainage - <br />0 <br />O <br />O <br />0 <br />co <br />N <br />69 <br />0 <br />0 <br />F-- <br />Z <br />W <br />2 <br />Q <br />W <br />0_. <br />-- CD c <br />E Z 0 <br />o Q u) <br />U W F- <br />o U <br />E (n <br />u) W m W <br />ce _I O <br />o <br />..0 0 0 W <br />Lc)W ro 0 <br />c o <br />'f W . Q <br />as tr,_) v Q <br />Q <br />0 _1 W <br />( r` <br />(Line 6 from prior Certificate) <br />0 <br />O <br />O <br />O <br />O <br />N <br />8. CURRENT PAYMENT DUE <br />0 <br />0 <br />O <br />O <br />)f') <br />0) <br />ARCHITEC <br />wn <br />Q <br />Z <br />F¢- <br />w <br />0 <br />z <br />0 <br />J <br />0 <br />z <br />z <br />L <br />O <br />N <br />0 0) <br />z M <br />m d <br />z <br />a) <br />0 @ <br />n. <br />~ O m U <br />Ala 0) <br />c <br />@ o c 0 <br />moa <br />Y E. <br />to' co <br />m <br />0 0 O <br />0 <br />C y O <br />0 o d m g oc0 <br />0 <br />DEDUCTIONS <br />0 <br />O <br />O <br />O <br />O <br />O <br />O <br />O <br />O <br />O <br />O <br />O <br />0 <br />$0.00 <br />0 <br />0 <br />O <br />(/) <br />O <br />O <br />Z <br />0)- <br />0 <br />_- <br />0 <br />0 <br />CHANGE ORDER SUMMARY <br />Total changes approved in previous. months <br />Total approved this month <br />i1) <br />NET CHANGES by Change Orders <br />O <br />F- <br />tO <br />