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APPLICATION AND CERTIFICATE FOR PAYM~~11' aiA DocuMENT G~o2 ~r~s«~~«o~s on re~~rs~ s~de> PAGE ONE OF PAGES TO OWNER: PROJECT: APPLICATiON NO.: 03 Dis[ribucion [o: M32'ion CAUilty Risk MandgP3fleIlt S31em .^AUY't.house Squai'e Pi'oject PERIOD TO: 5-4-97 ~$I OWNER 100 High Street, N.E. ASb2St05 AbdtCin2nt & DPmO PROJECT NOS.:NOriO ^ ARCHITECT Salem, Ox'egoR 97301 ^ CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE: 4-21-97 ^ Precision Industrial Constructors, Inc. O 1395-D Downriver Drive, Woodland, WA 98674 CONTRACT FOR: COfVTRACTOR'S APPLICATION FOR PAYMENT Application is made for paymenc, as shown below, in connec[ion with che Contracc. Concinua[ion Sheec, AIA Documen[ G703, is actached. The undersigned Contrac~or cerciFies [hat co the best of the Concrac~or's knowledge, infor macion and belief ehe Work covered by this Application for Payment has been comple[ed in accordance with the Concrac[ Documenrs, [hat all amounts have been paid by che Contractor for Work for which previous Cetcificates for Payment were issued and pay- ments received from~ che Owner, and chat curren[ paymenc shown herein is now due. ORIGINALCONTRACTSUM ..................~ 232,175.00 --- 2. Net change by Change Orders .........~......~ 3. CONTRACT SUM TO DATE (Line 1 t 2) ........~ Z32~ 175.00 4 . TOTAL COMPLETED & STORED TO DATE . . . . . . $ 161 , 870.60 (Co;umn G on G703) S. RETAINAGE: 6 943.53 a. _ ~_% of Comple[ed Work $ i (Columns D + E on G703) b. % of Stored Macerial $ (Column F on G703) Totai Retainage (Line Sa + Sb or 6 943.53 TotalinColumnIofG703)••~~~~~~~~.......5 . 6.TOTpL EARNED LESS RETAINAGE............$ 154,927.07 (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 79 448.62 (Line 6 from prior Certificace) . . . . . . . . . . . . . . . . . ffi ~ -8. CURRENT PAYMENT DUE ................. $ 75~478.45 9. BALANCE TO FINISH, INCLUDING RETAINAGE~O 304.40 (Line 3 less Line 6) . - $ ~ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Toral approved rhis Month TOTALS NET CHANGES by Change Order CONTRACTOR: gy; . R 4 E. hu tz State o . W~s1v- qton Coun of: COwlitz Subscribed and sworn to before me chis ~`f~ day of ~~e./ i997 / Dare:__-S-S_g7 Notary Publ' : ~ My Commi ' xp' s: ' // q G~'q ARCHITECT'S CERTIFICATE FOR PAYM~~9T In accordance wich che Contract Documencs, based on on-site observacions and che data comprising chis applicacion, che Archi[ect cenifies [o rhe Owner cha[ [o [he bes[ of the Archirect's knowledge, information and belief che Work has progressed as indicaced; che qualiry of ~he Wotk is in accordance wieh the Con[racc Documents, and che Contrac[or is enti[led co p9ymenc of che AMOUNT CERTIFIED. AMOUNT CERTIFIED ...............................8 (Attach explarzation ij amouna certified differs from the amount applied for. Inirial a[! figures on tbis Application and on the Continuation Sheet that are changed ro conform to tbe amount~certified.). ARCHITECT: By: Da~e: This Certificate is noc negotiable. The AbIOUNT CERTIFIED is payable only to the Con- [racror named herein. Issuance, paymene and acceptance of paymenc are withouc prejudice [o any rights of the Owner or Concractor under this Contract. ° AIA DOCUMENT G702 • APPLICATION AND CERTIFIG47E FOR PAYMENT • 1992 EDITION • Nw~ •~0799? • THE AMERICAN INSTITUTE OF ARCHITECTS, 1T55 NEW YORK `~ AVENiSE, N.W., WASHINGTON, D.C. 2000G5292 • WARNING: Unliee~ssed photacopying violates US. cop}rtight laws antl wlll wbject the violatar to legal pmseeution. G7OZ-'IJJZ 0 ~~1.ia CAUTION: You should use an orlginal AIA document whlch has thls caution printed in retl. An original assures that changes will not be obscured as may occur when documents are reproduced.