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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instruccions on reverse side) Pn~E oNg oF PAGES TO OWNER: Marion Co. & Salem Area Transit Attn: John Whittineton 3140 Del Webb Ave NE Salem.OR 97303-4165 FROM CONTRACTOR: pence/Kelly Construction, Inc. PO Box 4109 Salem, OR 97302-8109 CONTRACT FOR: 363 State Street Salem, OR 97301-3533 APPLICATION NO.: 9900600020 Distribution to: PERIOD TO: g/31/00 ~1 OWNER PROJECT NOS.: 99-006 ~7 ARCHITECT ~1 CONTRACTOR CONTRACT DATE: 2/17/99 ~ P~ - DH ~ P/K - MS CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies chat to the best of che Contnctor's knowledge, 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 with the Contract, in accordance with the Contract Documents, that all amounts have been paid by ~he Continuation Sheet, AIA Document G703, is attached. Contractor for Work f hich previous Certificates for Payment were issued and pay- ment ceived fro the wner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . 8 ~ Q dso dQd nn CO TRA R: Pence e ly Co struction, Inc. 2 . Net change by Change Orders . . . . . . . . . . . . . . . ~ ~ ~nn ~ti~ nn I 3. CONTRAGT SUM TO DATE (Line t t 2) ••..••••~ ~n ~s4 ~Sn nn BY~ v Dace: 8/29/00 4. TOTAL COMPLETED & STORED TO DATE ......~ ~n i n~ S~A nn (Column G on G703) • 5. RETAINAGE: a. ~g% of Completed Work E n nn (Columns D + E on G703) b. ___~.~gg% of Stored Material ~ n nn (Column F on G703) Total Retainage (Line Sa + Sb or ToralinColumnIofG703)..•••.•~••••~••••~ nnn 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . ~ ~n i n ~ s~A nn (Line 4 less Line 5 Tbtal) Stace of: Oregon County of: Marion Subscribed and sworn to before ~---~--- --- -.---.- OFFICIAL SEAL ' me this 29th~ y° u ~~,. (~A3'TIiE~b" ~. ~M~~k~ `'.., ,~ ,; ' NO'fARY PUBL±C - JREGOPI / COMMISSIO~d ~•;0. 903013 Notary Public / ~~ h~Y COMh41SSI0P1 EXP~RES JULY 14, 2001 My Commission expires: July 14, 2001 ~ ARCHITECT'S CERTIFICATE FOR PAYMENT 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data Line 6 froin rior Cert9flcate ~E 1 R~ ~~ nn 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 ................. ~ 1,128,351.0 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) E 558.172.00 AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S ( _T S ~~5~ • ~ (Attach explanation if amount certified differs from the amount applied for. Initia! CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Toral changes approved in previous months by Owner 2,215,072.00 -14,806.00 Total approved this Month TOTALS ~ + • ' > • NET CHANGES by Change Order 2,200,266.00 all figures on thfs A lication a d on the Continuation Sheet that are changed to conform to the a, nt c rtif' .) ARC T• osti Architects g : - Dace: ts Certificate is not negociable. The AMOUNT CERTIFIED is payab e only c the Con- cractor named herein. Issuance, paymenc and acceptance of payment are wit~ out prejudice co any riRhts of the Owner or Contractor under this Contract. ~' fLi ' AIA DOCUMENT G702 ~ APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDI7'ION • AIA~ • OO 1992 • THE AMERICAN INSTITUTE OF ARCHITEC7'S, 1735 NEW YORK ~~~~ pVENUE, NW., WASHINGTON, D.C. 20006-5292 •\NARNING: Unlicensed photocopying vtoletes U.S, copyrlgM lews and wiil subJect the vloiator to Iegai prosecutlon. 7OZ- ':~ii CAUTION: Vbu ahould use an orlginal AIA document which has thla caution printed in red. An original assures that chenges wlil not be obscured as may occur when documents are reproduced. PROJECT: Courthouse Souare Court & High Streets Salem, OR 97301 VIA ARCHITECT: q~buckle Costic Architects