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ZACHARY M GREEN <br />leesarY Pdoi,c <br />Sweet o Minnesr•a <br />My Cammession Expires <br />January31, 2028 <br />FOR PAYMENT <br />CATION AND CERTIF <br />J <br />a <br />a <br />0 <br />4- <br />c <br />O <br />4- <br />0 <br />_c w <br />z U z <br />O J <br />0 0 < u LL <br />Lf1 <br />APPLICATION NO: <br />TO (OWNER): <br />w <br />l7 <br />Z <br />2 <br />to <br />XI XI XI XI <br />Subcontract #0610 <br />HOFFMANN + UHLHORN CONSTRUCTION, INC. <br />PERIOD TO: <br />5555 W 78TH ST, SUITE A <br />MINNEAPOLIS, MN 55439 <br />FROM (SUBCONTRACTOR): <br />HOFFMANN + UHLHORN CONSTRUCTION, INC. <br />5555 W 78TH ST, SUITE A <br />MINNEAPOLIS, MN 55439 <br />Application is made for Payment, as shown below, <br />>- <br />0 <br />ce <br />0 <br />u_ <br />z <br />0 <br />I— <br />Q <br />J <br />0 <br />o_ <br />Continuation Sheet, AIA Document G703, is attached. <br />1. COMMITTED COST <br />w <br />0 <br />0 <br />H <br />0 <br />w <br />ce <br />0 <br />H <br />to <br />L_ <br />0 <br />- <br />v0 <br />0o 0)N <br />Q <br />a 0 0 <br />0 <br />2 o U w <br />< o <br />cz c <br />< EQ�1E <br />O O w �I 0 <br />U v <br />Lf1 <br />Lu <br />0 <br />z <br />H <br />w <br />CC <br />Lnru <br />Lu <br />0 <br />H <br />Lfl <br />w a1 <br />z c <br />CC J <br />Q <br />in in <br />aJ <br />0 0) <br />~ <br />DEDUCTIONS <br />$0.00 <br />0 <br />O <br />0 <br />tfr <br />0 <br />O <br />0 <br />by <br />Net change by Change Orders $8,407.00 <br />CHANGE ORDER SUMMARY <br />ADDITIONS <br />$8,407.00 <br />0 <br />0 <br />0 <br />O <br />C\ <br />0 <br />0 <br />0 <br />tb <br />t4 <br />Change Orders Approved in <br />previous months by Owner <br />TOTAL <br />Approved this Month <br />Date Approved <br />TOTALS <br />v <br />_0 <br />E <br />0 <br />z <br />7. LESS PREVIOUS CERTIFICATES FOR <br />m <br />Lfl <br />03 <br />co <br />0 <br />m <br />yr <br />PAYMENT (Line 6 from prior Certificate) <br />s_ <br />0 <br />4— <br />c <br />to O <br />O • - . <br />N Q <br />Q <br />O < <br />a,Lr) <br />_cE <br />O _0 <br />co ▪ -a <br />_c v <br />to ▪ a1 <br />Q1 > <br />Q <br />a, o <br />V <br />L <br />a1 Q1 <br />c <br />(- 0 _c <br />4- <br />c ,— <br />a1 <br />a1 <br />c� <br />0 <br />U c <br />E6 <br />O <br />Lrl <br />O <br />o CZ <br />U E <br />a1 O <br />Lfl <br />N <br />N <br />L(1 <br />CURRENT PAYMENT DUE <br />W <br />to <br />c <br />a1 <br />E <br />0 <br />0 <br />U <br />4- <br />c <br />0 <br />U <br />a1 <br />_c <br />CI) <br />0 <br />v <br />V <br />(0 <br />c <br />a1 <br />a1 <br />Q <br />E <br />0 <br />V <br />c <br />a1 <br />a1 <br />L <br />a✓ <br />c <br />a1 <br />E <br />N <br />N <br />01 <br />00 <br />LID <br />L(1 <br />9. BALANCE TO FINISH, PLUS RETAINAGE <br />ai <br />0 <br />c <br />v <br />c <br />0 <br />✓ <br />L <br />c <br />0 <br />L <br />VI <br />In <br />c <br />v <br />f6 <br />0 <br />c <br />a1 <br />4- <br />v <br />4— <br />ra <br />_c <br />(13 <br />(Line 3 less Line 6) <br />HOFFMANN + UHLHORN CONSTRUCTION, INC. <br />SUBCONTRACTOR: <br />c <br />0 <br />0 <br />0 <br />c <br />Q <br />State of: MINNESOTA <br />N <br />0 <br />O <br />Subscribed and swo <br />U <br />0 <br />0 <br />0 <br />z <br />03 <br />N <br />c <br />m <br />My Commission expires: <br />Date: 7/30/2026 <br />a <br />AMOUNT CERTIFIED <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />L <br />C- ll <br />0 <br />O_ <br />a <br />0 <br />0 <br />a (0 <br />E <br />0 <br />i a <br />N <br />• � Q a <br />- -mo <br />N <br />a T ON <br />(11 <br />0.) ▪ oUoN- <br />U <br />0 <br />0 <br />E <br />a <br />c <br />0 <br />0 <br />c <br />u <br />cu <br />U <br />• Q <br />In Accordance with the Contract Documents, based on on -site observations and the <br />v <br />L <br />113 <br />4- <br />0 <br />4--, <br />L <br />a1 <br />c <br />0 <br />a, <br />_c <br />0 <br />v <br />s_ <br />a1 <br />U <br />v <br />L <br />Q <br />✓ <br />+ - , <br />C <br />0 <br />v <br />0 <br />0_ <br />a1 <br />0 <br />_o <br />v <br />_c <br />b0 <br />c <br />O <br />E <br />0 <br />a1 <br />a1 <br />i0 <br />O <br />0_ <br />_c <br />4- <br />0 <br />aJ <br />_c <br />v <br />C <br />C0 <br />c <br />0 <br />E <br />0 <br />c <br />ai <br />03 <br />a▪ 1 <br />0 <br />c <br />u <br />a1 <br />LE <br />Q <br />a1 <br />_c <br />4- <br />0 <br />CD <br />w <br />L- <br />v <br />U <br />C <br />C0 <br />C <br />Q <br />a1 <br />L <br />0 <br />C <br />a, <br />E <br />>, <br />0_ <br />0 <br />aJ <br />C <br />v <br />a, <br />113 <br />0 <br />u <br />CU <br />c <br />0 <br />U <br />_c <br />