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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) P~~e oNE 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 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 ~ OWNER PROJECT NOS.: 99-006 TJ ARCHITECT ~I CONTRACTOR CONTRACT DATE: 2/17/99 ~ P~ - DH ~1 P/K - MS CONTRACT FOR: The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- CONTRAC'TOR'S APPLICATION FOR PAYMENT mation and belief the Work covered by this Application for Payment has been completed Apptication is made for payment, as shown below, in connection wich the Contract. in accordance with the C t Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for hich ~revious Certificaces for Payment were issued and pay- ments re ived from t e Owner~ and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . ~ i Q d~o aQd nn_ 2 . Net change by Change Orders . . . . . . . . . . . . . . . ~ ~ zd~ ~ ~ n nn_ 3 . CONTRACT SUM TO DATE (Line 1 t Z) . . . . . • , . ~ ' ~n Qm ~ od nn 4 . TOTAL COMPLETED & STORED TO DATE . . . . . . ~ ~n ~~~ ~~~ nn (Column G on G703) 5. RETAINAGE: a. ___g~g% of Completed Work ~ n nn (Columns D + E on G703) b. ~g~% of Srored Material ~ n nn (Column F on G703) Total Retainage (Line 5a + 5b or n nn TotalinColumnIofG703)••••••••~••••••~~~ 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . • • ~ ~n ~~i ~~~ nn (Line 4 less Line 5 Total) By; -~-~~ y~ v v • - Scace of: Oregon County of: M Subscribed and w~orn to before Inc. Date: 9/26/00 me this 26th day of epte 0 t OFFtCiAL SEAL ~ - _ ~A~TT1~~4i' L SM!!TH ~~G7ARY PUBL{C - ONEuON CO~~PAISSiOPJ iJO. 303Qt3 Notary Public: ~ ' ~_ ~ ~ k1Y COE4~AISSlON EX?iRES .J!.!!.Y 1~, 240? My Commission expires: Julv 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 from prior Certificate) ~n ~n~ S~R nn 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 8. CURRENT PAYMENT DUE ~ 669,689.00 quality of the Work is in accordance with the Contracc Documents, and the Contractor .......... ....... is entitled to payment of the AMOUNT CE . 9 . BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . • . • . 8 l~ ~ ~ ~~~ ' °O (Line 3 less Line 6) ~ 3Q,42'I.00 (Attach explanation if amount certiJied difjers jrom the amount applied jor. Initial 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 > > • ' ' NET CHANGES by Change Order 2,342,710.00 al! jigures on this Applica 'on and on the Cont:nuatson Sheet that are changed to conform to the amount c rtifie .) ARCHITECT: Arb de stic Architects ~ By; % Date: ~ This Certifi / negotiable. The AMOUNT CERTIFIED is payab e 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. L, AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • t992 EDITION • AIA~ •~01992 ' THE AMERICAN [NSTITUTE OF ARCHITEC75, 1735 NEW YORK G7O 9Z AvENUE, N W., WASHINGTON, D.C. 2000G5292 • WARNING: Unlicenaed photocopying vlolates U.S. copyright ~ewa and wlll subject the vlolator to legal prosecution. s~,~ CAUTION: You should use an original AIA document which has this caution printed in red. An origlnal assures that changes will not be obscured as may occur when documents are reproduced.