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~' ~ ~ ~~ ~-PPL_.;ATION AND CERTIFICATE FOR PAYM~.JT AIA DOCUMENT G702 (Instructions on reverse side) P.+cE ~Ne oF PAGES TO OWNER: M~~ Co. ~ SalemArea Transit PROJECT: Courthouse Square APPLICATION NO.: 9~~42 Distribution to: Attn: John Whittington PERIOD TO: 4/30/99 ~] OWNER 3140 Del WebbAveNE PROJECT NOS.: 99-006 ^ ARCHITECT Salem, OR 97303-4165 ~] CONTRACTOR FROM CONTRACTOR: PencelKelly Construction, Inc. VIA ARCHITECT: ~~ckle Costic Architects CONTRACT DATE: 2/17/99 $] P/K - DH PO Box 4109 363 State Street g] p/g _~ Salem, OR 97302-8109 Salem, OR 97301-3533 CONTRACT FOR: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies thac to che best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payfnent, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Wor or which previous Certificates for Payment were issued and pay- ments received fr m the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . E 18,459,484.00 CON .RA R: 2 . Net change by Change Orders . . . . . . . . . . . . . . . ~ 24,942.00 3. CONTRACT SUM TO DATE (Line 1 t 2) ........~ 18.484,426.00 BY~ ''~ Date: 4/28/99 4. TOTAL COMRLETED & STORED TO DATE ...... f 346,619.00 (Column G on G703) : 5. RETAINAG : l?,zi3l,•e a.~7. •% of Completed Work S -1-~g6:96' (Columns D + E on G703) b. 0•~'/0 of Stored Material ~ 0.00 (Column F on G703) Total Retainage (Line Sa + Sb or 1"j~33~. e.. Total in Column I of G703) . . . . . . . . . . . . . . . . .1 1~66:96- ZSf3 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . f 3?,Q,~00 (Line 4 (ess Line 5 Tocai) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 froin prior Certificate) . . . . . . . . . . . . . . . . . t 108.803.00 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . t 220,~39:00 9. BALANCE TO FINISH, INCLUDING RETAINAG~ '~ g 15S .00 (Line 3 less Line 6) t > > CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS NET CHANGES by Change Order S24 942.00 State of: pregon County of: IV18ti0I1 Subscribed and sworn to before me this 28th day f April-99 Notary Public: ,r My Commission expires: July 14, 2001 OFFIClAL SEAL ~A`ST~lE~i ~. S~ieTii ~JOTARY PUBLIG - O~EGON GQlAsdISS10?~ N0. 3Q30t3 ~4Y CC~~?fi~ISSIC1td EXFIR[S JULY 14, 2001 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documencs, based on on-sice observations and the dara comprising this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~_ ~~_ S..o (Attach explanatfon if amount certified differs from the amount applied jor. lnitia! all figures on this Application and on the Continuation Sheet that are changed to conform to the a ount ce :fied.) ARCHITECT: By: =T Date: _~=~ This C ot negotiable. The AMOUNT CERTIFIED is payable on y to the Con- tractor named herein. Issuance, payment and acceptance of payment are without prejudice ro any rights of the Owner or Contractor under this Contract. ~~ AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDIT[ON • AIA~ •~01992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1~35 NEW' YORK ~`'R~'~~ AvENUE, N~r~., ~~c~aSHiNGTON, DC 20o0G5292 • WARNING: UnOcensed photocopying violates U.S, copyright Isws and wiil subject the violator to legal prosecution. G702-19J2 i !'~i C ION: You should use an oriGinal AIA document which has this caution prtnted In red. An original assures that changes wlll not be obscured as may occur when documents are reproduced.