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APPLICATION AND CERTIFICATE FOR PAYM~iVT aiA nocuMErrT G~oa ~~~5«u«;on5 0~ ~~~~5~ s,d~~ PAGE ONE OF PAGES TO OWNER: PROJECT: APPLICATION NO.: 03 Distribu~ion to: MdZ'lOR County Risk Management Sd12m ~uit.hOllse SquaY'2 PY'Oject PERIOD TO: 5-4-97 ~ OWNER 100 High Street, N.E. Asbestos AIJdtPIfl2llt & D2rt10 PROJECT NOS.:NOne ^ ARCHITECT Salem, Oregon 97301 ^ CorrTxnC'rox FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE: 4-21-97 ^ Precision Industrial Constructors, Inc. ^ 1395-D Downriver Drive, Woodland, WA 98674 CONTRACT FOR: COIVTRACTOR'S APPLICATION FOR PAYMENT Applicacion is made for payment, as shown below, in connection wich the Contract. Concinua~ion Sheet, AIA Documenc G703, is actached. '. ORIGINALCONTRACTSUM ..................5 232,175.00 --- -~2. Net change by Change Orders .........~......8 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) 5 . RETAINAGE: y, g43.53 a. _~°/, of Comple~ed Work S (Columns D + E on G703) b. % of Scored Matetia] 5 (Column F on G703) Torai~Retainage (Line Sa + Sb or 6,943.53 Toral in Column I of G703) . . . . . . . . . . . . . . . . . $ G.TOTAL EARNED LESS RETAINAGE............5 154,927.07 (Line 4 less Line 5 Toca1) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 79 448.62 (Line 6 from prior Cercificace) . . . . . . . . . . . . . . . . . S ~ -8. CURRENT PAYMENT DUE ................. S 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 Total approved [his Mon[h TOTALS NET CHnNGES by Change Order The undersigned Con[nctor cen~es chat co che besc of che Concnctor's knowledge, infor- ma[ion and belief che Work covered by this Application for Paymenc has been completed in accordance with the Concract Dowments, chat all amoun[s have been paid by the Con[raccor for Work for which previous Cer[ificates for Payment were issued and pay- ments received from~che Owner, and chat current payment shown herein is now due. CONTRACTOR: BY R 4 E. ultz Sta[e o . Tnras ' gton Coun of: ~litz Subscribed and sworn eo before me this ~`'1~ day of ~~/ i997 / Da[e: 5_5_q7 In accordance with che Coneracc Documents, based on on-si~e observations and [he data comprising chis appliea[ion, che Arehitect cer[i£ies eo che Owner thae to the best of ehe Archi[ect's knowledge, informa~ion and belief che Work has progressed as indicared; the qualiry of the Work is in accordance wieh [he Contracc Documents, and che Concractor is enci[led ro paymen[ of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ............................... (Aetach explanation if amourzt certified differs jrom rhe amount applied for. lnitial a!! figures on tbis Applitation and on the Continuation Sheet that are changed to conform to the umounrcertified.). ARCHITECT: By~ Date: This Cercificace is not negoeiable. The AbtOUNT CERTIFIED is payable only to [he Con- cractor named herein. Issuance, payment and acceptance of payment are without prejudice co any righ[s of che Owner or Con~racror under [his Concracc. ° AIA DOCUMENT G702 • APPLICATION AND CERI7FIChTE EOR PAYMENI' • 1992 EDITfON • AU1~ • 01992 • THE AMERICAN INSTITUTE OF ARCHITECfS, 1735 NEW YORK ~ AvENUS, N.W., WnSHING70N, D.C. 2000G5292 • WARNING: Unlicensed photocopying violates U.S. copyrigM laws and will subject the violator m legal prosecution. G702-7992 ~:~~' CAUTION: You should use an origlnal AIA document which has thls caution printed in red, An original assures that changes will not be obscured as may occur when documents are reproduced ARCHITECT'S CERTIFICATE FOR PAYIVI~sd~