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APPLICATION AND CERTIFICATE FOR PAYMENT .~A DocuMErrT G~oz ~~tN~tio~ on re~e~e 5~de~ PA~E oNE oF PAG~S TOOWNER: MarionCo.&SalemAreaTiansit Atm: Jolw Whittin¢ton 3140 Del Webb Ave NE Salem.OR 97303-4165 FROM CONTRACTOR: PencR/KClly COnstlvcfiOx4, InC. PO Box 4109 Salem, OR 97302-8109 CONTRACT FOR: PROJECt CouRhouse Sauare Court & Fi'igh Steeu Salem, OR 97301 VIA ARCHITECT: Arbuckle Costic AtcLitects 363 State S~eet Salem, OR 97301-3533 APPLICATION NO.: PERIOD TO: PROJECT NOS.: CONTRACT DATE: 9900600012 Disttibution toa 1/31/00 ~ OWNER ~~6 ^ ARCHITECT~~ C7~ CONTRACTOR 2/17/99 ~ P/K-DH ~ P/K - MS CONTRACTOR'S APPLICATION FOR PAYMENT Applica[ion is made for paymenc, as shown below, in conneccion wich [he Concrac[. Concinuacion Shee[, AIA Documenc G703, is atrached. ORIGINALCONTRACTSUM I ..5 18.459484.00 ............... , . Net change by Change Orders . . . . . . . . . . . . ? . . . S 1.636 622.00 . CONTRACT SUM TO DATE (Line 1 t 2). .... 3 ...8 20.096 106.00 . -i . TOTAL COMPLETED & STORED TO DATE . . . . . . $ 10.835.084 00 (Column G on G703) 5. RETpINAGE: a 0 OOo~, of Compte~ed Work S 0.00 (Columns D + E on G703) 6 O.OOo~o of Stored Material S 0.00 (Column F on G703) Tocal Retainage (Line 5a + 5b or ~ .~~ TotalinColumnIOfG703) ~~•$ ~~~ •~....••. ~ 6. TOTAL EARNED LESS RETAINAGE. . . . . . . . . . . . S 10,$}5 R,Q_4 ~~ (Line 4 less Line 5 Total) 7 LESS PREVIOUS CERTIFICATES FOR PAYMENT The undersigned Contracror certiFia [hac ro the best of che Conttactor's knowledge, inforv mation and belief che Work covered by [his Applica[ion for Paymen[ has been compleced in accordance wi[h che Con[racc Documcn[s, cha[ all amoun[s have been paid by [he Contractor for Work for which previous Certifica[es for Payment were issued and pay- me received f m he Owner, and chat currenc paymenc shown herein is now dve. Co rRn oR: P lly Conshvction, Inc. gy; Da[e: t/~/nn Srace of: pregon County of: ~on Subscribed and sworn to before me this 25th day of J~ OFFICIAL SEAL MATTHEW L SMITH ~~ /` NOTARY PUBLIC - OflEGON Nonty Public: ,. COMMISSION N0. 303013 My Commission expires: July 14, 2001 MY COMMISSION EXPIRES JULY 14, 2001 ARCHITECT'S CERTIFICATE FOR PAYMENT (,~-' In accordance with [he Contract Documents, based on on-site observaaons and che data (Line 6 from rior Cercificare 8 8.782.188-00 ~omprising chis applicacion, che Archicecc cercifies co che Owner chac to ~he besc of [he P ~ ' ' ' ' ' ' ' ' ' ' ' ' ' ~ ' ' ' Architect's knowledge, information and belief the Work has progressed u indicated, the 8. CURRENT PAYMENT DUE ................. S 2,052,896.0 quali[y of che Work is in accordance wi[h [he Concrac[ Documen[s, and che Concraccor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) g 9,261,022.00 AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ST Zt S°~6. (Attach vxplana[ion ij amount certijied differs from tbe amount applied jor. /ni[ia! CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Tocal changes approved in previous monchs by Owner 1,337,393.00 -14,806.00 Tocai approved this Mon[h TOTRLS ' ' ' ' NET CHANGES by Change Order > ' a![ figures on this Applicatton arzd on the Conzirzuation Sheet rhat are changed to conform to tbe ao 63en.t certified.) ARCHITE ~ buc] eCostic.4rchitects gy, ~ Da[e: o Z oZ Zcr~ T rcif e is noc nego[iable. The AMOUNT CERTIFIED is payablc only [o the Con- traccor named herein. Issuance, payment and acceptance of payment are withopt prejudice to any rights of the Owner or Contraccor under [his Contract. / AIA DOCUMENT G702 • APPI]UTION AND CEFR7FICA7E FOR PAYMENC • 1992 EDITION • AIA~ •~01992 • THE AMERIGIN INSfITUTE OF ARCHITEC[5, 1T35 NEW YORI( ~~d' qVENUE, N W., WASHINGTON, D.C. 2000G5292 • WARNING: Uniloensed photornpyln9 Wotates U.S, copgrlgM lews and w10 subJeat tha violaMr to Iegal piosecuHon. R ~'A\\i CAUTION: You should use an original AIA document whlch has this eautlon printed in retl. An origlnal assures that ehanges will not be obseured as may oecur when