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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructtons on reverse side) rnce oNe oe 'Pn~ss TO OWNER: ~0n Co. 8~ SalemArea Transit PRO ECT: Co ouse Square 9900600003 Attn: John Whittington J APPLICATION NO.: Discribucion co: PERIOD TO; 5/31/99 3140De1WebbAveNE PROJECT NOS.: 99-006 ^~ CHETECT Salem, OR 9'1303-4165 FROM CONTRACTOR: CONTRACT FOR: Pence/Kelly Construction, Inc. Arbuckle Costic Architects 2/17/99 ~ CONTRACTOR VIA ARCHITECT: CONTRACT DATE: [~ P~-DH PO Box 4109 363 State Street ~ P~ _~ Salem, OR 9~302-8109 Salem, OR 97301-3533 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the besc of the Contractor's lcnowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection wich the Contract. in accordance with the Contract Documencs, that all amounts have been paid by the Concinuation Sheet, AIA Documenc G703, is attached. Contractor for Wo for which previous Certificates for Payment were issued and pay- 18 459 484.00 m~nts eived fr m th'e Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . S_ _ _ > > i 2 . Net change by Change Orders . . . . . . . . . . . . . . . 8 83,209.00 CbNTRAC R: 3. CONTRACT SUM TO DATE (Line 1 t 2) ......., t 18,542,693.00 BY. a. TOTAL COMPLETED & STORED TO DATE .,.... S (Column G on G703) 5. RETAI E: a. ~~/o of Comple~ed Work ~ 54,467.00 (Columns D + E on G703) b. ~'~/o of Stored Material ~ 0•~ (Column F on G703) To~al Retainage (Line 5a + 5b or Total in Column I of G703) . . . . . . . . . . . . . . . . . f 1,089,306.00 State of: Oregon County of: Marion Subscribed and sworn to before me this 26~ day of M~Y-99 Notary Public: 54,46'7,00 C . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . .~ 1,034,839.00 (Line 4 less Line 5 Total) LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) . . . . . . . . . . . . . . . . . 329,288.00 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . ~ '705,551.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE17,S0~,854.00 (Line 3 less Line 6) ~ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS NET CHANGES by Change Order ~ • Dace: S/26/99 OFFICIAL SEAL ib3ATTHEW L SMITH ft07ARY PUBLIC - OREGON COMMISSION N0. 303013 MY COMMfSSION EXPIRES JULY 14, 2001 My Commission expires: luly 14, 2001 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance wi~h the Concract Documents, based on on-site observations and the data comprising this application, che Architect certifies to the Owner that to the best of the Architect's knowiedge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Concracc Documents, and the Contracror is entitled to payment of the AMOUNT CERTIFIED. AMOUN7 CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 70~,~~~ c~e (Attach explanation :f amounf certtfied differs jrom the amount applied jor. Jnitia! a11 figures on this Application a on the Continuation Sheet that are cbanged to conform to the ount certi,fi ARCHITECT: BY~ _ ~ Dare: This Certificate is noc negotiable. The AMOUN~C_ERTIFIED is payable onty to the Con- tractor named herein. Issuance, payment and acceptance of paymenc are without preJudice co any rights of ~he Owner or Contracror under this Contract. AIA DOCUMENT G7pQ • APPLICATION AND CERTiFICATE FOR PAYMENT • 1992 EDITION • AIA~ • ~01992 • TNE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK ;1~~~~ AVENUE, N.\r!. ~~'ASHINGTON, D.C. 200oC-5292 • WARNING; Unilcensed photocopying vlolates U.S, copyright laws and wfii subJect the violator to legal prosecutlon. G702-1992 ::a~: CAUTION: You should use an orlginal AIA document which has thls cautfon printed In red. An origlnnl assures thnt chenges will not be obscured es may occur when documents ere reproduced