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~ \ ~ ~-.. -ri ~r_eTinN oN~ CERTIFICATE FOR PAIr ~r1ENT AIA DOCUMENT G702 (Instructions on reverse side) PncE oxE oF PAGES Marion Co. & SalemArea Transit PROJECT: Courthouse Square APPLICATION NO.: 9900600001 Distribution to: TO OWNER: Attn: John WhittinBton 3/31/99 PERIOD TO: ^ OWNER 3140 Del Webb Ave NE PROJECT NOS.: 99-006 Q ARCHITECT OR 97303~165 Salem ^ CONTRACTOR , FROM CONTRACTOR: P~~elly Conshuction, Ina VIA ARCHITECT: ~~uckle Costic.Arehitects CONTRACT DATE: ~17/99 ~ ^ PO Box 4109 363 State Street 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 Applicacion for Payment has been completed Application is made for payfnent, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by che Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- 18,459,484.00 ments received fro the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . ~ 0.00 CON CTOR. 2 . Net change by Change Orders . . . . . . . . . . . . . . . ~E ~ 18,459,484.00 By: Date: 3 . CONTRACT SUM TO DATE (Line 1 t 2) • • • • • • • • ~ 114,529.00 State of: ~~so n 4. TOTAL COMPLETED & STORED TO DATE ......~ ~ t f rnQ~'o1- (Column G on G703) ' 5. RETAI~I~GE: 5,726.00 a. /o of Completed Work ~ (Columns D + E on G703) b. ~•~~% of Stored Material ~ 0.00 (Column F on G703) Total Retainage (Line 5a + 5b or ~ 5,'726.00 TotalinColumnIofG703)~•••••••••••••••• ~ ARNED LESS RETAINAGE 108,803.00 . . . . . . . . . . . . 6 . TOTAL E (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 0~ (Line 6 froin prior Certificate) . . . . . . . . . . . . . . . . . E 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . E 108,803.00 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 Total approved this Month TOTALS NET CHANGES by Change Order 0.00 ounyo: ~ Subscribed and sworn to before me this lS"~ day o A ~~ Notary Public: 9q My Commission expires: 1- (~t- Z~O 1 OFFICIAL SEAL AAATTHEW L SMITH ,, ;'' NOTARY PUBLIC - ORE(i0N COMMIS510N N0. 303013 MY COMMISSION EXPIRES JULY 14, 200 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 che 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 ~ ~~- ~-~ . ~ (Attach explanation if amount certified dijfers from the amount applied for. Initial all figures on this Ap ation and on the Continuat{on Sheet that are changed to conform to the am certifie . ARCHIT . By, Date: ~ This Certificate is not negotiable. The AMO~JNT CERTIFIED is payab e o y 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 • AIA~ •~01992 ~ THE AMERICAN [NSTITUTE OF ARCHITECTS, 1735 NEW YORK (a`~Q_~992 AVENUE, Nw., WpSHINGT'ON, D.C. 200oCr5292 • WARNING: Unlicensed photocopy~n9 violatea U.S. coPYrigM lewn end witl aubject the vio~etor to legal prosecutloo• 1+: : CAUTION:1'~nu should use an oHginel AIA document which has thts caution printed in red. An original assurea that changes wili not be obscured as may occur when documents aro roproduced.