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/~~o~a ~ /a~q7 ~~ ~d~o?~ APPLICATION AND CERTIFICATE FOR PAYPlE4vT AiA DocuMErrT G~oa cIns~=~«,ons o~ ~e~e~5e 5~de~ P~~E oNE oF PA~es TO OWNER: , PROJECT: Marion County Risk Management Salem Courthouse Srn,~re Project 100 High Street, N.E. Asbestos Abatement &~~ Salem, Oregon 97301 FROM CONTRACTOR: ~ ~~88(p rI VIA ARCHITECT: N/A ~ Precision Industrial Constructors, Inc. 1395-D Downriver Dr., Woodland, WA 98674 co~rxncT Fox: ~3/O-,~~3- 79.3.5 APPLICATION NO.: 01 Distribution co: PERIOD TO: 4-20-97 ~OWNER PROJECT NOS.: NOne ^ pRCHITECT ^ CONTRACTOR CONTRACT DATE:4-21-97 ^ /oa a~ ~o 0 3~s68 /A~ooa CONTRACTOR'S APPLICATION FOR PAYMENT Applica[ion is made for payment, as shown below, in conneccion wich [he Con~race. Continuation Sheet, AIA Doeument G703, is actached. 1. ORIGINAL CONTRACT SUM ...................9 232,175.00 2. Netchange by Change Orders ...............s --- 3. CONTRACT SUM TO DATE (Line 1 t 2)........~ z32~175.00 4. TOTAL COMPLETED & STORED TO DATE ......~ Z3, 000.00 (Column G on G703) 5. RETAINAGE: a. _y_°/, of Comple[ed Work g 1,150.00 (Columns D + E on G703) b. % of Srored Material .S (Column F on G703) Totai Retainage (Line Sa + 56 or TotalinColumnlofG703)•••..•.•.••••~•••~ 1,150.00 6.TOTAL EARNED LESS RETAINAGE............5 21,850.00 (Line 4 less Line 5 Toral) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Line 6 from nor Certificare ~ -~ ( P ) ................. -3. CURRENT PAYMENT DUE ................. $ 21 ~850.00 9. BALANCE TO FINISH, INCLUDING RETAINAGEO 325.00 (Line 3 less Line G) . ~ S ~~ ~ CHANGE ORDEF SUMMARY ADDITIONS DEDUCTIONS Toral changes approved in previous monchs by Owner Toral approved chis Monch ~ TOTALS NET CHANGES by Change Ordet The undenigned Contractor cartifies thac ~o che best of the Concracror's knowledge, infor- ma[ion and belief the Work covered by [his Application for Payment has been comple~ed in acwrdance wi~h [he Contnet Documenu, that all amounes have been pzid by the Con~racror for Work for which previous Certificates for Payment were issued and pay- mencs received from the Owner, and thac currenc payment shown herein is now duc. CONTRACTOR: gY. esident Da~e4-21-97 o e E. S z Sta of: ashington Counry ~litz Subscribed and swom co before me chis Ql~~ day of ~2 ~ ~ Notary Public: Q~~~~'~`'/~ . My Commissi expi ': //-999 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance wieh che Concrace Documents, based on on-sice observations and [he dara comprising this application, the Archirec[ cenifies ro the Owner thac to che best of [he Archirec['s knowledge, informacion and belief [he Work has progressed as indica[ed~ [he qualiry of the Work is in accordance wi[h [he Con[ract Documencs, and the Concracror is encitled ro payment of [he AMOUN7' CERTIFIED. AMOUNT CERTIFIED ............................... (Attach exp(anatiorz ijamount certijied differs from the amount applied Jor. laitial a[[ figures on this Application and on tbe Continuation Sheet that are c%anged to confornz to the amount certified.), ARCHITECT: By: Da~e: This Certificare is not negociable. Tf~e AbIOUNT CERTIFIED is payable only ro[he Con- [ractor named herein. Issuar,ce, payment and acceptance of paymene are wichouc prejudice [o any righ[s of the Owner or Coneracror under this Con~rac[. ° AIA DOCUMENT G/02 • APPLICATION AND CERTIF7CATE FOR PAYMENT • 1992 EIDTION • AIA~ •~0199? • THE AMERIGN INSTITUTE OF ARCHITECIS, 7735 NEW YpRK ~ AvENGE, N.W., WnSHINGTON, D.C. 2o00G5292 • WARNING: Unlicensed photxopying vlolates US wpyright laws and will subject the violaror m legal prosecution. G7OP-1JJ2 CAUTION: You should use an origlnal AIA doeument which has this eaution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced