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APPLICATION AND CERTIFICATE FOR PAYMENT`nia DocuMErrT G~oa ~~~5~r~~~~ons o~ ~e~~~se s~de~ rA~L oNE oF PAGES TO OWNER: Marion County Risk Management 100 High Street, Salem, OR 97301 FROM CONTRACTOR: PROJECT: Salem Courthouse Square Project Asbestos Abatement & DPmo VIp qRCH1TECT: Precision Ind. Constructors, Inc. 1395-D Downriver Dr., Woodland, WA 98674 CONTRACT FOR: ~ CONTRACTOR'S APPLICATION FOR PAYMENT Applica[ion is made for payment, as shown below, in connection with che Contrac[. Con[inuacion Shee[, AIA Documenc G703, is actached. ORIGINALCONTRACTSUM ..................5 Z32,175.00 -2. Net change by Change Orders .. . . . ... . . . . .. . 3. CONTRACT SUM TO DATE (Line 1 t Z) ••..•... E Z32,175.00 4. TOTpL COMPLETED & STORED TO DATE ...... b 232,175.00 (Column G on G703) 5. RETqINAGE: a. % of Compleced Work (Columns D + E on G703) b. % of Stored Materia] 8 (Column F on G703) Totai Retainage (Line Sa + Sb or Total in Column I of G703) . . . . . . . . . . . . . . . . . G.TOTAL EARNED LESS RETAINAGE............E 232,175.00 (Line 4 less Line 5 Toral) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 220 566.25 (Line 6 from prior Cer[ificate) . . . . . . . . . . . . . . . . . $_ ~ -es.CURRENT PAYMENT DUE ................. 8 11,608.75 Retaina 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) . ~ E -~_ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Toal changes approved in previous monchs by Owner Total approved chis Mon[h TOTALS NET CHANGES by Change Order APPLICATION NO.: O5 scribu[ion to: PERIOD TO: 5-25-97 ~ ~ OWNER PROJECT NOS.: None ~ ^ nRCHITECT ^ CONTRACTOR CONTRACT DATE: 4-27-97 ~~.,^ ^ REPAINAGE BILLING The undersigned Contractor cercifies chat ro the besc of rhe Con~rac~or's knowledge, infor- macion and belief che Work covered by this Applicacion for Payment has been comple~ed in accordancc wich che Contrac[ Documents, thac all amouncs have been paid by che Contraccor for Work for which previous Certificaces for Payment were issued and pay men~s received from~ the Owner, and that current paymene shown herein is now due. x CONTRACTOR: ~ ~ ,~ BY~ Date: 5-29-97 ~ ~ dney E. Schult pC~jy S~a[e of• Wash~nctton ~{L V County of: ~Iitz ~ Subscribed and sworn ro befote ' ~JUN 2 ~~ me [his ~' G~ day of ~~ , No[ary Public: My Commission expir : ~ RISK NAANAGE/v4EN~F ARCHITECT'S CERTIFiCATE FOR PAYMENT In accordance wich che Contract Documenes, based on on-site observacions and che data comprising chis applica[ion, [he Archi[ecc car[ifies to [he Owner [haC to the best of [he Archi~ecc's knowledge, informaeion and belief [he Work has progressed as indicated~ [he quality of che Work is in accordance wich [he Contraa Documencs, and che Contracror is enti[led to payment of che APvIOUNT CERTIFIED. AMOUNT CEFiTIF1ED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Attacfi explanation if amount certiJied differs jrom the amount applied jor. /nitia! all figures on tbis Application and on the Continuation Shee! Lbat are changed to conform to the amourzt~certified.), ARCHITECT: , By: Date: This Cercificate is not nego[iable. T~ic .47vI0UNT CERTIFIED is payable only co ehe Con- ttac[or named herein. Issuancc, payment and accep[ance of paymenc are wichovc prejudice to any righ[s of che Owner or Concrec[or under chis Con[ne[. °~ AIA DOCUMENT G702 • APPLIGTION AND CEAI7FIGTE FOR PAYMENT • 1992 EDIIION • AIA~ •~01992 • THE AMERIUN INSTI'IUTE OF ARCHCI'ECIS, 185 NEW YORK ~~~~, AVENItE, N.W., WaSHtNGiON, D.C. 2000G5292 • WARNING: UnllcenuM photocopying vloiates US. copyright Iaws and wlll subject the vlol tor to egal utlon. (i7~2-y992 ~ ~cr ~~~l~47 CAUTION: You should use an original AIA document whlch has thls caution prlnted in red. An originai assures that changes wil~ not be o scured as may occ n documents are reproduced.