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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G7OZ ~II1SLillCIlOI1S OIl iC99OOC)0OOO1PAGE ONE OF PAGES Courthouse Square APPLICATION NO.: Distribution to: TO OWNER: M~on Co. & Salem Area Transit PROJECT: 3/31/99 ~ pWNER ~ Attn: John Whittington PERIOD TO: PROJECT NOS.: 99-006 ~ ARCHITECT 3140 Del Webb Ave NE ^ CONTRACTOR Salem, OR 97303-4165 2/1'7/99 pence/Kelly Construction, Inc. VIA ARCHITECT: ~~uckle Costic Architects CONTRACT DATE: ~ FROM CONTRACTOR: 363 State Street ~ ~ PO Box 4109 Salem, OR 97302-8109 Salem, OR 97301-3533 CONTRACT FOR: The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- CONTRACTOR'S APPLICATION FOR PAYMENT mation and belief the Work covered by this Application for Fayment has been completed Application is made for payment, as shown below, in connection with the Contract. Contrac or for Wo ktfor which pre~v ous1Certific teslfor Payment werb is uedla dypaye Continuation Sheec, AIA Document G703, is attached. ments received from t wner, and that current payment shown herein is now due. 18,459,484.00 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . ~ CON OR: $ 0.00 2 . Net change by Change Orders . . . . . • • • ~ • • ~ • ~ Dace: 18 459,484.00 By: 3 . CONTRAGT SUM TO DATE (Line 1 t 2) . . ~ ~ ~ ~ ~ ~ ~ O~so ~ 114,529.00 State of: 4. TOTAL COMPLETED & STORED TO DATE ......8 County of: C'flar'~o~ (Column G on G703) 5. RETAI~~GE: a, % of Completed Work (Columns D + E on G703) b, ~•~~°/o of Stored Material (Column F on G703) Total Retainage (Line 5a + Sb o Total in Column I of G703) g 5,726.00 0.00 ` 5,726.00 ................~ 108,803.00 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . 8 (Line 4 less Line 5 To[al) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ~ 0.00 (Line 6 from prior Certificate) . . . • • • • 108,803.00 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . ~ 9. BALANCE TO FINISH, INCLUDING RETAINAGE1g~350,681.00 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Toral approved this Month TOTALS NET CHANGES by Change Order 0.00 Subscribed and sworn to before 9q me this lS-4' day of {~~'~ ~ ~ Notary Public: My Commission expires: 1- «-4' 2~ ~ ~ ~ OFFICIAL SEAL .~ :ial~YTHEW ~. SMITH ~~uTRRY PUBLIC - OREGON COMMISSION N0. 303013 ~fY CGA~NISSION EXPIRES JULY 14, 2001 ~- - ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the daca 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .t~S~~1~01-° (Attach explanation if amount certified differs from the amount applied for. Initia! all figures on this Ap cation and on the Continuation Sbeet that are changed to conform to the amo t c tified.) ARCHITE . Date: By: This ' eTs not negotiable. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. Issuance, payment and acceptance of payment are withouc prejudice to any rights of the Owner or Contractor under this Contract. ~Rrt1 AIA DOCUMENT G~02 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA~ • O~ 1992 ' THE RICAN INSTITUTE OF ARCHITECI'S, 1735 NEW YO ~ G7O2-1992 ~`';11'r~~ AvENL'E, N W, WASHINGTON, D.G 20006-5292 • WARNING: Iicensed photocopying vlotates U.S. I n~ll subJect the vlolator to I ~ p V ~~n. , ~_ re~ TIAN• v~u ahouid use an orlainal AIA document whic h s t Is cautlon pri red. An original assures t at changes wlll not be obscu may occur when documents are reproduced. ~;t~, ~ ~t ~~ ~ ~~ ~,~~ ~