Laserfiche WebLink
f~PLICATI~I G~ID CERTIFICATE FOR PAYt~NT <br />ORI6I~. CONTRACT SlR4 <br />lU tu~K): I~RIf~I C.OUMTY <br />10@ HI6H 5T. NE <br />5~EM, OR 9731@ <br />FR~ lCOMTRACTOR? : STATDN CONSTRl~TION, It+~. <br />29394-B Airport Road <br />Eugene„ OR 97482-9594 <br />~ #: l~41) 461-054s' <br />PROJECT: MAAION CO/SALpq/DEMO <br />229 HIGH ST. <br />Sf~.EA1, OR 9731 @ <br />VIA (ARCHITECT): <br />CANTRACT FOR: <br />~ICATION t~: 3 DATE 06/27/97 <br />~RIOD T0: @6/P7/97 <br />ARCHITECT~S <br />PROJECT N~: <br />C(~JTRACT DATE: <br />[~iAt~ ORDER ~RY <br />I ADDITIONS I DEDUCTIONS I <br />(~IAIV6E OADERS APPROVED IN I I I <br />PREVIOUS t~lTHS BY ~ArER I I I <br />f I I <br />ANPRDVED THIS M~NTH I I I <br />I I I <br />IV~ER I DATE A{~ROVED I I I <br />~ I I I <br />~ I I I <br />I I I I <br />I I I I <br />1 I I I <br />I I I I <br />I I I I <br />I I I ~ <br />TOT~S I I I <br />_ ~ i I <br />I'ET (~iAN6E I I I <br />BY CF~h16E ORDERS I I I <br />I I I <br />The undersigned Contractor certifies that ta the best of the <br />Contractor's knor-ledge, infor~ation and belief the NorN <br />covered by this Appliration for Pay~ent has been co~pleted <br />in accordance Nith the Contract Docu~ents, that all a~ounts <br />have been paid by the Contractor for work for ~ich previous <br />Certificates for Pay~ent Here issued and pay~ents received <br />fro~ the ONner, and that current pay~ent shorm herein is noN <br />due. <br />CO~ITRACTOR: ~ ~ <br />~ Date: ~~~ <br />BY~ C~~~"~iG~~~~ ~;~~_ ~ ~ <br />I~T CHFI~ BY CF~IGE ORDERS <br />CONTRACT 51~i TO DATE <br />TOT~ CDt~+LETED A~lD STO~D TO DATE <br />RETAIt~E: <br />5.@X of Co~pleted Hork 186,560.8@ <br />5.0% of Stared Material <br />Total Retainage <br />TOT~ EARt~D LESS f~TAII~ <br />LESS PREVIOUS CERTIFICATES ~ PAYlIENT <br />CURf~ENT SALES TAX: <br />@.~OX of Taxable A~aunt <br />Current Sales Tax <br />CUARENT RAYpENT M~ <br />518,579.00 <br />5]8, 579. ~ <br />1Bb, 568. 0@ <br />9, 328. ~ <br />177,232.~ <br />I28,569.20 <br />rn <br />~ <br />2o~g <br />~ c~ Q ~ <br />~ u~ ~ <br />[~Z~rn <br />cn~4~~ <br />~ 'z° <br />~d~oi5 <br />a~:Z <br />u~.~'r~~o <br />oU~1~ <br />o ~ <br />z ~ <br />~~~U <br />8 <br />~ <br />48,662.88 <br />RG~E 1 <br />. ~: <br />B~d I ISH, II~L II~ 1, 347. @@ ~ <br />State af: ~,~~Q~~lL County of: ~Q/Z~ <br />Subacribed and sNOrn to before ~e this ~/~~ day ov~,~,199~ <br />My Conission expires: Cv-h/-99 <br />ARCFIITECT'S CERTIFICATE FOR PAYMENT <br />In accordance Nith the Contract Doru~enta, based on on-site <br />observations and the data co~prising the above application <br />the Architect certifies to the OMmer that to the best of the <br />Architect's knoHledge, infor~ation and belief the Nork has <br />~~qressed as indicated, the quality af the Work is in <br />rdance aith the Contract Docu~ents, and the Cantractor <br />r~'entitled to payeent of the W4~JNT CERTIFIED. <br />~l1NT CERTIFIED <br />i <br />ARC~IITECT• <br />~~-d-~ <br />BY~ Date: 3D ~j' 7 <br />This Certification is not negotiable. The ~+IOUNT CERTIFIED is <br />payable only to the Contractor na~ed herein. Issuance, pay~ent <br />and acceptance of pay~ent are Nithout prejudice to any rights <br />of the Owner or Gontractor under this Contract. <br />