3650553 - Laserfiche WebLink

Home Browse Search

APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) Pn~E otvE 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: PROJECT: Courthouse Sauare Court & High Streets Salem, OR 97301 VIA ARCHITECT: ~buckle Costic Architects 363 State Street Salem, OR 97301-3533 APPLICATION NO.: 9900600021 Distribution to: PERIOD TO: 9/30/00 ~1 OWNER PROJECT NOS.: 99-006 ~ ARCHITECT ~1 CONTRACTOR CONTRACT DATE: 2/17/99 ~ P~ - DH ~1 P/K - MS CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . ~ i A ds4 dud nn z . Net change by Change Orders . . . . . . . . . . . . . . . ~ ~ zd~ ~ ~ n nn 3. CONTRACT SUM TO DATE (Line 1 t 2) ••......~ ~n Qm i oa nn ~ . TOTAL COMPLETED & STORED TO DATE . . . . . . ~ ~n ~~ ~ ~~~ nn (Column G on G703) 5. RETAINAGE: a. ~pg% of Completed Work $ n nn (Columns D + E on G703) b. _~gg% of Scored Material ~ n nn (Column F on G703) Total Retainage (Line 5a + Sb or TotalinColumnIofG703)•• ••••••••••••••$ nnn 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . ~ ~n ~~ ~ ~~~ nn (Line 4 less Line 5 Total) ?. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) . . . . . . . . . . . . . . . . . $ ~n in~ ~~R nn 8 . CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . ~ ~ 669,689.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 30,927.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 2,215,072.00 -14,806.00 Total approved this Month 142,444.00 TOTALS 2, 5 ,5 . - . NET CHANGES by Change Order 2,342,710.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Co tor for Work hich previous Certificates for Payment were issued and pay- nts re ived fro the wner, and that current payment shown herein is now due. NT CT Pence ly Construction, Inc. gy: ~ Date: 9/26/00 State of: Oregon Councy of: Marion Subscribed and sworn to before me chis 26th day of September-00 ~~ K¢.j~~ pOTFpF~pICpIA~{~LpS~A~L9T y~ ~ rIC?~9 f NT~'NC l~ ~IYId 0 dl ~~O~fiRY Pli~~ !~ - OREGON ~ ~~~'~' COI~MiSSiQ~d N0: 30301~ Notar Public: . ~ ~''f y ~ F~Y CGMh~SI,rsSid~J EXPI~itS JiiLY 14, ~Q~ ~~ My Commission expires: Julv 14, 2001 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ (Attach explanation if amount certified differs from the amount applied for. Initial al! figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) ARCHITECT: Arbuckle Costic Architects gy; Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • A[A~ •~01992 • THE AMERICAN [NSTITUTE OF ARCHITECTS, 1735 NEW YORK ,~vENUE, N.W., wASFtINGTON, D.G 2ooo(r5292 • WARNING: Unlicensed photocopying vlolates U.S. copyright laws and wfll subJect the violator to legal prosecution. G702-~992 .'~y •~~ CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes wlll not be obscured as may occur when documents are reproduced.