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ARPLICATIDN AND CERTIFICATE FDR PAYMENT TO fOWNER): p1AAI0N COUNTY PROJECT: MARIO~~ CO/SALEM/DfMO 1N@ HI6H ST. NE ~c@ HI6H ST. SALEM, OR 9731Q SALEM, OP, 97310 FRQM (CONTRACTOR): STRTON CONSTftUCTION, INC. UTA lARCHITECT): c9394-A Airport Road Eugene„ OR 9740~-9594 PHONE #: f541) 461-@54s' C(NJTRACT FOR: PAGE 1 AF~PLICATIDN N0: 1 DATE 06/13/97 PERIOD TD: 05/~1/97 ARCHITECT'S PROJECT N0: CONTRACT DATE: (~iANGE ORDER SUMMARY ORI6I1~ CONTRACT SUM 518,579.I~ I ADDITIDNS I OEDUCTIONS I NET CHAt~E PV CHAN6E ORDERS CFIA~E ORI~RS APGROVEU IN I I I GREVIDUS piO~~TH5 AY ~1NER I I I CONTRACT 51~1 TO DATE 518, 579. @0 I I ~ ~'PROVED THIS MLI~ITH I I I I I TDTAL COPIPLETED AND STDRED TO DATE 61, 785. @@ I F~1t4RER I DATE AF'PROVED I I I I RETAINF~: I I I i I I I S.NX of Co~pleted Nork 61,785.Q~ I I I I I I I I 5.0% of Stored Material I 1 I I I I I I Tatal Retainage 3,089.25 I I I I I I I I TOTAL EAf~lED LESS RETAIF~ 58,695.75 TOTAI.S I I 1 ~ ~ I I LE5S Pf~VI~ CERTIFICATES OF PAYM~NT PlET qi~E I I I BY CI~I~ ORDERS I I I I CUA(~NT SALES TAX: I I @.@@x of Taxable A~ount The undersigned Cantractor certifies that to the best of the Contractor's knor-ledge, infar~ation and belief the work Current 5ales Tax covered by this Application for Payient has been co~pleted in arcordance with the Contrart Dacu~ents, that all a~ounts CURRENT PAYI~NT Dl~ 58,695.75 have been paid by the Cantractor for work for whirh previous Certificates for Pay~ent Nere issued and payeents received BAL~JCE TO FINISH, I UDING RETRI 459,883.25 fro~ the Owner, and that current pay~ent shawn herein is noH due. (XINTRf~TDR: State of: ~~(~<~~~` County of: l--Q~~ gy; Q ~ Date: G /3j ~ 'P ~ 9 ~ Subscribed and SNOrn to hefore ~e this %~~ day of,~ ~~~ ° "-=---------- -- -- My Couission expires: (~--y-99 ARCHITECT'S CERTIFICATE FOR PAYh~NT In accordance with the Contra~t Docu~ents, based on on-site observations and the data co~prising the above application the Architect certifies to the Owner that to the best of the Rrchitect's knoHledge, infor~ation and belief the Work has p ~ssed as indicated, the quality of the WorH is in a, ~ance Hith the Contract Docu~ents, and the Contractor is entitled to pay~ent of the AMOUNT CERTIFIED. ~ ~o"$ C7W~~ ~3¢g~ ~a~o~ oV}~~ ~$ ~ ~ AMOUNT CERTIFIED S ARCHITECT: py; Uate: This Certification is not negotiahle. The AMOUNT CERTIFIED is payable only to the Contr~artor na~ed herein. Issuance, pay~ent and acceptance of pay~ent are Hithout pr•ejudice to any rights of the Owner or Contra~tor under this Contract.