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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) P~ce oxe oF PAGES TO OWNER: j~on Co. & Salem Area Transit PROJECT: Courthouse Sauare APPLICATION NO.: 9900600010 Distribution to: Aitn: John Whittington Court & High Streets PERIOD TO: 11/30/99 ~ OWNER 3t40 Del Webb Ave NE Salem, OR 97301 PROJECT NOS.: 99~ ~] ARCHITECT Salem. OR 97303~I65 ~1 CONTRACTOR FROM CONTRACTOR: PenCe/Kelly Construction, Ine. VIA ARCHITECT: Arbuckle Costic Architects CONTRACT DATE: v17/49 ~ P/K - DH PO Box 4109 363 State Street ~ P/K - MS Salem, OR 97302-8109 Salem, OR 97301-3533 CONTRACT FOR: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's tcnowledge, infor- mation and belief the Work covered by this Application for Payment has been compieted Application is made for payment, 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 Work for which previous Certificates for Payment were issued and pay- ments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . ~ 18,459,484.00 CONTRACT R ence/Kelly Construction, Inc. 2 . Net change by Change Orders . . . . . . . . . . . . . . . E 860.906.00 3. CONTRACT SUM TO DATE (Line 1 t 2) ........~ 19320.390.00 By: Date: ~ ~/~~l~s~ 4. TOTAL COMPLETED & STORED TO DATE ......~ 7,797.809.00 Srace of: gon (Column G on G703) County of: ~rion S RETAINAGE• Subscribed and sworn to before a, 0.00 a/o of Completed Work t 0.00 (Columns D + E on G703) b. ~•~ % of Stored Material $ 0.00 (Column F on G703) Total Retainage (Line Sa + Sb or Total in Column I of G703) • . • . . . • . . . . . . . . . . t 0.00 me this 24th day of Nov 9 Notary Public: My Commission expires: Ju]y 14, 2001 OFFICIAL SEAL [~4ATTHEW L SMl1'ii ~' ` ±':0 ~ARY PUBLIC - OREGON ~ ~~°' COMMIS510N N0. 303013 R,;Y CG`:7~+SSIOPa EXPIRES JULY 14, 2001 6. TOTAL EARNED LESS RETAINAGE . ............~ 7_797,809.00 ARCHITECT'S CERTIFICATE FOR PAYM (Line 4 less L1ne 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT In accordance with the Contract Documents, based on on-site observatidns and~t~e dara Line 6 froin r~or Certificate ,~ 6,395,245.00 comprising this application, the Architect certifies to the Owner that to the best of the ~ p ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Architect's knowledge, information and belief the Work has progressed as indicated, the 8. CURRENT PAYMENT DUE .................~_ 1,402,564.00 quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) ,~ 11,522,581.00 AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E ' ~6 y (Attach explanation if amount certified differs jrom the amount applie for Initial CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 875,7I2.00 -14,806.00 Total approved this Month TOTALS ~ ' ~ • NET CHANGES by Change Order ~ • all figures on this pplication and on the Continuation Sheet that are changed to conform to the a ount certijied.) ARCH Arb 1 Costic Architects By: Date: 2 This rtificate is not negotiable. The AMOUNT CERTIFIED is paya le o y to the Con- ~ractor named herein. Issuance, payment and acceptance of payment are withouc prejudice ro any rights of the Owner or Contracror under this Contract. A A AIA DOCUMENT G702 • pPPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA~ •~01992 • THE AMERICAN INSTITUTE OF ARCHITECIS, 1735 NEW YORK ~``R ~g pVENUE, N.W., WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocropying vlolates U.S, copyrigM laws and wiil subJect the vlolator to legal prosecutlon. ~/\ .C7~2 99Q 3aM t, \,L\ O`t' CAUTION: You should use an original AIA document which has this cautlon printed In red. An originat assures that changes will not be obscured as may occur when documents uced.