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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PncE orre oF ~~A~Es TO OWNER: Maz.ion 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 C(~NTRACT FnR: PROJECT: Courthouse Sauaze Court & High Streets Salem, OR 97301 VIA ARCHITECT: ~buckle Costic Architects 363 State Street Salem, OR 97301-3533 APPLICATION NO.: 9900600020 Distribution to: " PERIOD TO: 8/31/00 ~1 OWNER PROJECT NOS.: 99-006 ~ ARCHITECT ~I 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 CONTRAGT SUM . . . . . . . . . . . . . . . . . . ~ ~ Q aso dud nn 2 . Net change by Change Orders . . . . . . . . . . . . . . . ~ ~ ~nn ~~~ nn 3 . CONTRACT SUM TO DATE (Line 1 t 2) • • • • • . • • ~ ~n ~s4 ~sn nn 4. TOTAL COMPLETED & STORED TO DATE ......~ ~n i ni S~A nn (Column G on G703) ~ 5. RETAINAGE: a. ___p~gg% of Completed Work ~ n nn (Columns D + E on G703) b. ~;gg% of Stored Material ~ _ n nn (Column F on G703) Total Rerainage (Line 5a + Sb or TotalinColumnIofG703)•••••••••••••~•••~ nnn 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . ~ ~n ~ n ~ S~A nn (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) . . . . . . . . . . . . . . . . . ~ 1 R,97't,~.27 O0 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . ~ 1,128,351.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) ~ 558.172.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 2,215,072.00 -14,806.00 Total approved this Month TOTALS 2> > • - ° ' NET CHANGES by Change Order 2,200,266.00 AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA~ •~01992 • THE AMERICAN INSTITUTE OF ARCHITECT'S, 1735 NEW YORK G7OZ-1992 AVENUE, N.W., WpSHINGTON, D.C. 200oCr5292 • WARNING: Unlicensed photocopy~~9 ~oletea U.S. copy-~gM laws and witl subJect the vblator to legal prosecution. CAUTION: Vbu should use an orfginal AIA document which has this caution printed in red. An original assu-es that changes will not be obscured as may occur when documents are roproduced. The undersigned Contractor certifies that to the best of the Gontractor's xnowieage, incor- macion 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 Contractor for Work for which previous Certificates for Payment were issued and pay- ment received from t wner, and that current payment shown herein is now due. CONT OR: P nce y Construction, Inc. gy. Date: 8/29/00 ~- . me this Zq~ d y o ~,u OFfICIAL SEAL ~ AAA3TIiE11~ ~ ~INll~li '~ fi~a7ARY PUBLif; - QREGON Notary Public: ' COMMISSION E'~0. 303013 My Commission expires: MY COMRSlSSION ~XPlRES JUIY 1A, 2J41 Julv 14 2001 State of: Oregon County of: Marion Subscribed and sworn to before ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observacions and the data comprising this application, the Architect certifies to the Owner that to the best of the Architect's knowiedge, 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. lnitial all figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) ARCHITECT: Arbuckle Costic Architects By. 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 withouc prejudice to any rights of the Owner or Contractor under this Contract.