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AQPLICATION AND CERTIFICAfE FOR PAYMENT'niA DocuMErrT G~oa ~~ns~r~~aoa~ on ~e~~tse s~ae~ PAGE ONE OF PAGFS TO OWNER: Marion County Risk Management 100 High Street, Salem, OR 97301 PROJECT: Salem Courthouse Square Project Asbestos Abatement & DPmo FROM CON'TRACTOR: VIA ARCHITECT: Precision Ind. Constructors, Inc. 1395-D Downriver Dr., Woodland, WA 98674 CONTRACT FOR: ~ APPLICATION NO.: O5 7~1 s[ribucion to: PERIOD TO: 5_25_97 . 'C~ OWNER PROJEGT NOS.: NOne . ^ ARCHITECT ^ CONTRACTOR CONTRACT DATE: 4-21-97 ~,L] ^ RETAINAGE BILLING CONTRACTOR'S APPLICATION FOR PAYMENT npplicacion is made for paymen[, as shown betow, in conneccion with che Contracc. Con[inua~ion Sheec, AIA Documenc G703, is actached. ORIGINAL CONTRACT SUM ..................5 232~175.00 -"2. Net change by Change Orders ............... 3. CONTRACT SUM TO DATE (Line I t 2) ••...... 8 232 ~ 175.00 4. TOTqL COMPLETED & STORED TO DATE ......8 232,175.00 (Column G on G703) 5. RETAINAGE: a. % of Complc~ed Work (Columns D + E on G703) b. % of Scored Material S (Column F on G703) Torai Rerainage (Line Sa + 5b or _0_ Total in Column I of G703) . . . . . . . . . . . . . . . . . S 6.TOTAL EARNED LESS RETAINAGE............8 232,175.00 (Line 4 less Line 5 To[al) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 220,566.25 (Line 6 from prior Cer[ifica[e) . . . . . . . . . . . . . . . . .8_ -zs.CURRENT PAYMENT DUE ................. S 11,608.75 Retaina 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) . ~ $_ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Toral changes approved in previous monchs by Owner Total approved this Month TOTALS NET CHANGES by Change Order The undersigned Con[rrccor cerciFia triac co [he besc of the Con[rdc[or's knowledge, infor- macion and belief [he Work covered by this Applica[ion for Payment has been completed in accordance with ~he Concract Documents, thac all amouncs have been paid by thc Contraccor for Work for which previous Certificaces for Payment were issued and pay- menrs received from~the Owner, and that curren[ paymenc shown hetcin is now due. : CONTRACTOR: ~' ~~ By: Dare: 5-29-97 ` dney E. Schult Scace o~W~hlnclton ~~ Counry of: ~Iitz Subscribed and sworn to before ' ~JUN 2 ~~ mc [his ~~ day of ~~ Notary Public: My Commission expir : ~~ ~- , RISK Ik1AnIAGEi~EN~ ARCHITECT'S CERTIFiCATE FOR PAYMENT In accordance with che Conerdc[ Documen[s, based on on-si[e observa[ions and [he dan comprising [his application, the Archirec[ cer[ifies to the Owner [ha[ to the best of [he Archi[ect's knowledge, informa[ion and belief ehe Work has progressed as indicaced; che quality of che Work is in accordxnce with the Contract Documents, and che Concraccor is en[ided to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ............................... (Attacb explanation ij amount certijied difjers jrom the amount applied jor. lxitia! a!! figures on tbis Application and on the Continuation Sheet that are changed to confor»z to tbe amount~certijied.), ARCHITECT: , By: Dace: This CertiFicate is not negociable. T~ie AMOUNT CERTIFIED is payable only to che Con- traccor named he:ein. lssuancc; payment and acceprance of payment are wi[hout prejudice ~o any zights of che Owner or Coneractor under this Coneracc. ~ AIA DOCUMENT G702 • APPLIGTfON AND CER'IIFICATE FOR PAYMFNT • 1992 EDI770N • AIAm •~01992 • THE AMERIGN INSTITUTE OF ARCHITECfS, 1735 NEW YORK ~~~ AVENUE, N.W., WASHINGTON, D.C. 2000b5292 • WARNING: Unlicensed photocopying vl0iale5 US copyrlght laws enE wlll subJeCt Ne Vlol to~ M¢gal iro ecuuon. G702-1992 ~i 1~ ~~'~1l~~~~ CAUTION: You should use an origlnal AIA document which has thls cautlon printed In red. An origfnal assures that changes wiil not be o seured as may occ n documents are reproduced.