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Innsdale Tank Certificate for payment TMI_ICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 TMI Job No. 11 -5269 J (OWNER): PROJECT: DEDUCTIONS Distribution to: City of Cottage Grove Innsdale Ground Storage Tank APPLICATION NO: OWNER 7516 South 80th Street Rehabilitation - Cottage Grove, MN 2 ENGINEER Cottage Grove, MN 55016 VIA: PERIOD TO: CONTRACTOR FROM(CONTRACTOR): S.E.H. (651) 765 -2973 7/26/2011 TMI Coatings, Inc. Doug Klamerus, P.E. 3291 Terminal Drive 3535 vadnais Center Drive CONTRACT NO: Eagan, MN 55121 Saint Paul, MN 55110 CONTRACT DATE. CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with Contract. CHANGE ORDER SUMMARY Continuation sheet, AIA Document G703, is attached The undersigned Contractor certifies that to the best of the Contractors Knowledge information and belief the Work covered by this Application for Payment has been completed in accordance with the 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. 1. ORIGINAL CONTRACT SUM 2. Net change by change orders 3. CONTRACT SUM TO DATE (Line 1 +- 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a 6 7 $ $454,400.00 $ $0.00 $ $454,400.00 $ $445,400.00 5% of Completed Work $ $22,270.00 of Stored Material $ (Column F on G703) Total Retainage (Line 5a + 5b or Total in Column I of G703) TOTAL EARNED LESS RETAINAGE LESS PREVIOUS CERTIFICATES FOR PAYMENT CURRENT PAYMENT DUE BALANCE TO FINISH, PLUS RETAINAGE (LINE 3 LESS LINE 6) $ $22,270.00 $ $423,130.00 $ $284,016.75 $ $139,113.25 $ $31,270.00 CONTRACTOR: TMI COATINGS, INC. State of: MINNESOTA CAWVYA14N STIC KN OO Subscribed and sworn to before me 5bo August 2011 �p MY COMMISSION Notary Public: Cq•, lrc� EXPIRES JAN. 31, 2015 By: Date: 08/05/11 My Commission xpire I ° >/ AMOUNT C D $ 13 7 (13 CERTIFICATE FOR PAYMENT (Attach lanation i unt certified differs from the amount applied for.) In accordance with the Contract Documents, based on on -site observations and the / data comprising the above application, the Architect certifies to the Owner that to the By: Date: ��zz O �� best of the architects knowledge, information and belief the work has progressed as This certifl e is no e e. The AMOUNT CERTIFIED is payable only to the indicated, the quality of the work is in accordance with the Contract Documents, and Contractor name ei . suance, payment and acceptance of payment are without the Contractor is entitled to payment of the AMOUNT CERTIFIED. p rejudice to any rights of the Owner of contractor under this Contract. Change Orders approved in previous months by Owner TOTAL ADDITIONS DEDUCTIONS Approved this month Number Date Approved TOTALS1 $0.00 1 $o.00 Net change by Change Orders $0.00 The undersigned Contractor certifies that to the best of the Contractors Knowledge information and belief the Work covered by this Application for Payment has been completed in accordance with the 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. 1. ORIGINAL CONTRACT SUM 2. Net change by change orders 3. CONTRACT SUM TO DATE (Line 1 +- 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a 6 7 $ $454,400.00 $ $0.00 $ $454,400.00 $ $445,400.00 5% of Completed Work $ $22,270.00 of Stored Material $ (Column F on G703) Total Retainage (Line 5a + 5b or Total in Column I of G703) TOTAL EARNED LESS RETAINAGE LESS PREVIOUS CERTIFICATES FOR PAYMENT CURRENT PAYMENT DUE BALANCE TO FINISH, PLUS RETAINAGE (LINE 3 LESS LINE 6) $ $22,270.00 $ $423,130.00 $ $284,016.75 $ $139,113.25 $ $31,270.00 CONTRACTOR: TMI COATINGS, INC. State of: MINNESOTA CAWVYA14N STIC KN OO Subscribed and sworn to before me 5bo August 2011 �p MY COMMISSION Notary Public: Cq•, lrc� EXPIRES JAN. 31, 2015 By: Date: 08/05/11 My Commission xpire I ° >/ AMOUNT C D $ 13 7 (13 CERTIFICATE FOR PAYMENT (Attach lanation i unt certified differs from the amount applied for.) In accordance with the Contract Documents, based on on -site observations and the / data comprising the above application, the Architect certifies to the Owner that to the By: Date: ��zz O �� best of the architects knowledge, information and belief the work has progressed as This certifl e is no e e. The AMOUNT CERTIFIED is payable only to the indicated, the quality of the work is in accordance with the Contract Documents, and Contractor name ei . suance, payment and acceptance of payment are without the Contractor is entitled to payment of the AMOUNT CERTIFIED. p rejudice to any rights of the Owner of contractor under this Contract. IINUATION SHEET AIA DOCUMENT G703 PAGE: 2 OF 2 PAGES APPLICATION NUMBER: 2 AIA D t G702 APPLICATION AND CERTIFICATE FOR PAYMENT containing APPLICATION DATE: 08/05/11 ocumen , I Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: PROJECT NO: 7/26/2011 City of Cottage Grove, MN Innsdale Ground Storage Tank Rehabilitation TMI Job No: 11 -5269 A B C D I E F G H I WORK COMPL MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % BALANCE RETAINAGE FROM PREVIOUS THIS NO. VALUE APPLICATION PERIOD STORED & STORED (G +C) TO FINISH (D + E) (NOT IN TO DATE 5% DORE) (D +E +F) 1 Mobilization & Site Work $40,000.00 $30,000.00 $10,000.00 $40,000.00 100% $0.00 $2,000.00 2 Containment $15,000.00 $15,000.00 $0.00 $15,000.00 100% $0.00 $750.00 3 Repair & Modifications $39,500.00 $37,525.00 $1,975.00 $39,500.00 100% $0.00 $1,975.00 4 Dehumidification $8,000.00 $4,000.00 $4,000.00 $8,000.00 100% $0.00 $400.00 5a Interior Wet Abrasive Blast $80,100.00 $72,090.00 $8,010.00 $80,100.00 100% $0.00 $4,005.00 5b Interior Wet Prime Coat $26,500.00 $23,850.00 $2,650.00 $26,500.00 100% $0.00 $1,325.00 5c Interior Wet Finish Coat $26,500.00 $0.00 $26,500.00 $26,500.00 100% $0.00 $1,325.00 6 Valve Vault & Piping $3,000.00 $1,500.00 $1,500.00 $3,000.00 100% $0.00 $150.00 7a Exterior Abrasive Blast $75,000.00 $75,000.00 $0.00 $75,000.00 100% $0.00 $3,750.00 7b Exterior Prime Coat $25,000.00 $25,000.00 $0.00 $25,000.00 100% $0.00 $1,250.00 7c Exterior Intermediate Coat $25,000.00 $0.00 $25,000.00 $25,000.00 100% $0.00 $1,250.00 7d Exterior Finish Coat $25,000.00 $0.00 $25,000.00 $25,000.00 100% $0.00 $1,250.00 8 Miscellaneous Concrete $1,000.00 $0.00 $1,000.00 $1,000.00 100% $0.00 $50.00 9 Miscellaneous Electrical $30,000.00 $9,000.00 $12,000.00 $21,000.00 70% $9,000.00 $1,050.00 10 Site Restoration $1,000.00 $0.00 $1,000.00 $1,000.00 100% $0.00 $50.00 11 De -Icing Units $2,000.00 $1,000.00 $1,000.00 $2,000.00 100% $0.00 $100.00 12 Interior Caulking- 1,0001f at $3 $3,000.00 $0.00 $3,000.00 $3,000.00 100% $0.00 $150.00 13 Interior Grinding -50hr at $100 $5,000.00 $1,500.00 $3,500.00 $5,000.00 100% $0.00 $250.00 14 Exterior Caulking -1501f at $2 $300.00 $0.00 $300.00 $300.00 100% $0.00 $15.00 15 New Cathodic Protection Sys $13,000.00 $0.00 $13,000.00 $13,000.00 100% $0.00 $650.00 16 Two (2) Year Warranty $1,000.00 $0.00 $1,000.00 $1,000.00 100% $0.00 $50.00 Alt A Hatches on Vault Yard $6,000.00 $0.00 $6,000.00 $6,000.00 100% $0.00 $300.00 Alt B I Sump in Floor of Tank $3,500.00 $3,500.00 $0.00 $3,500.00 1 100% $0.00 $175.00 TOTAL $454,400.00 1 $298,965.00 $146,435.00 $0.00 $445,400.00 1 1 $9,000.00 $22,270.00