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A~PLICATION AND CERTIFICqTE FOR PAYMENT AIA DOC . _4`_`_`
<br />I'c> c)~~'N~K UMENT G702 (Instrucnons on reverse side) i~nc~e orvt: c~r i>ne,i.
<br />Marion Co. & Salem prea Transit PROIECT:
<br />Attn: John VVhittineton Co~o~ S0~'e APPLICATION NO.:
<br />3140 Del Webb Ave NE CO~ `~ ~~ Sti'~s 9900600008 Distribution to:
<br />Salem, OR 97301 PERIOD TO: 9/30/99 ~ OWNER
<br />Sa1em OR 97303-4165 PROJECT NOS.: 99-006 ^ ARCHITECT
<br />r~zc~n~ c~c>!v'~'~z.~c°~'c~-t: Penee/Kelly Construetion Ine.
<br />PO BOX 4109 ' ~lA ARCF{1"I'EC'i'; ,qrbuckle Costic Architects ~ CONTRACTOR
<br />CONTRACT DATE: 2/17/99 ~ P/K - DH
<br />Salem, OR 97302-8ip9 ~3 State Street
<br />C_ONTRACT FOR: Salem, pI~ 97301-3533 ~ P~K - MS
<br />~,....~.- -
<br />~+V IV 1 t'fH(,;1 V R'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that ro the best of the Contractor's knowledge, infor-
<br />Application is made for payment, as shown below, in connection wich the Contract.
<br />mation and belief che Work covered by this Appiication for Payment has been completed
<br />Continuation Sheet, AIA Document G703, is attached. in accordance with the Contract Documents, that all amounts have been paid by the
<br />1. ORIGINAL CONTRACT SUM ...,...,, Con accor for Work for which previous Certificates for Payment were issued and pay-
<br />• •~~ 18 459 484.00 m n~s re 'ved fr e Owner, and thac current payment shown herein is now due.
<br />_' . Net change by Change Orders . . . , , . , . . C NTRACTOR:
<br />~~•••~$ 761 924.00 PeII euy Construction, Inc.
<br />~. CONTRACT SUM TO DATE (Line i t 2) ..,,.,,, g 19 221 408.00
<br />-+ . TOTAL COMPLETED & STORED TO DATE ...... BY~ L Date: 10/6/99
<br />(Column G on G?03) ~ 5,191,9~0.00 Sca~e of: Qregon
<br />~ . RETAINAGE: County of: Marion
<br />,1. 0.00 <y~ ~f Completed Work Subscribed and sworn to before
<br />(Columns D + E on G703) $ ~~~
<br />me this 6th da ._._,_~_
<br />~~ ~•~ "/„ of Storcd Material OfFICIAL SEAL
<br />(Column F on G703) ~ ~'~ MA7TIiEW L SP~NITH
<br />Total Recainage (Line Sa + 5b or , ~dOTARY PUBLIC - OREGON
<br />Notary Public: ~~~~ COMI~fSSION N0. 303013
<br />Tocal in Co(umn I of G703) ...,...,, E~'f COFRt~ISSION EXPIRES JULY 14, 2001
<br />' ' ' ' ' ~ ~ ~ ~ 0.00 MY Commission expires: Jujy j4~ 2001 -
<br />.
<br />c~. TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . ..~ 5,191 970.00 qRCHITECT'S CERTIFI
<br />c~.+nt 4 ~~5~ Line 5 Total) CATE FOR PAYMENT
<br />'. LESS PREVIOUS CERTIFICATES FOR PAYMENT In accordance with ~he Contract Documents, based on on-site observation
<br />(Line 6 from prior Cercificate) . . . . . , .
<br />••••••• S 4,261 757.35 comprising this application, the Architect certifies ro the Owner that to ~he be, e thc
<br />N. CURRENT PAYMENT DUE ....... Architect's knowledge, information and belief che Work has progressed as indicated, the
<br />'' '~~•••• ~ 930,212.65 quality of [he Work is in accordance with the Contract Documents, and the Contractor
<br />~) . BALANCE TO FINISH, INCLUDING RETAINAGE ~ ~
<br />s en~i[led co payment of the AMOL'NT CERTIFIED.
<br />(Line 3 less Line O ,~ 14,029,438.00
<br />AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ ~~[3,~J~r
<br />CHANGE ORDER SUMMARY ADDITIONS (Attacb expla~zation if amount certified dijfers from the amount upplied for Initiu!
<br />8 pproved in 699,062.00
<br />Total chan es a DEDUCTIONS a[[ jzgures on this App[ication and on the Continuation Sbeet that are changed tu
<br />pre~~ious months by Owner conform to the~ount ce ified.)
<br />Tocal approved this Month ARCH~ C.~ Ar c Costic ArcMtects
<br />~ •
<br />TOTALS ~ • ---______ Date: _ 1 ~~7~~ oyge~
<br />NET CHANGES by Change Order , . 's Cer ificate ~s not negotiable. The AM T CERTIFIED is payable only to che Con-
<br />tractor named herein. Issuance, payment and acceptance of payment are withc~ut
<br />prejudice to any rights of the Owner or Cnnrro.•r..~ ,...a__ _~_. ..
<br />,~~~~~ AIA DOCUMENT G70? . e uw ~.-.r.,... ._
<br />^~~v ~crcurl(:ATE FOR PAYMENT • "'~+ ~ii» ~-UnUaCt.
<br />\ ~Y / A~'ENl'E N ~X~ ~
<br />A~A 01992 • THE AMERICAN WSTITUTE OF ARCHITECTS, 1'35 NEW YORK
<br />;~N~~ .~XAtiHIN(,TON, D.C. 20pp~.j29~ . yyqRNING: Unltcensed photocopyi gNvtolates U.S. copyright laws and will subJect the vioiator to I
<br />~~_ .... ~~
<br />~i ~
<br />CqUTION: You e98~ prosecution. ~2_~992
<br />~d use an originai AIA document which has thts cautton printed in red. An orig~....r~assures that changes wili not be obccura.~ ,~ ,„,,.. „__.._ ..__.
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