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F~LICATIt~J AND I~RTIFICATE FOA PAYMENT TO t0{~lER) ; MARItII~! CfA1NTY IQr@ H1GH Sl . PIE S4~EM, OR 97310 ,~ FtitlM tCOP1TR~ICTOR): 5TRTON CAt~STRUCfIUN, INC. 29394-A Airport Road Eugene„ OR 974d2-9594 RHUNE ~: l~41) 461-N°,43 RRDJECT: MARION CO/SALEM/DEMO 220 HI~ ST. Sf~EM, DR 97310 VIA tARCHITECT): CONTRACT FOR: PAGE 1 ARPLICATIDN N0: 4 (3ATE 07/04/97 PERIOD T0: 07/@4/97 ARCHITECT'S PRD.TECT N0: (~NTRACT DATE: CHi~ OHDER Sl~'P1ARY I ADDITI~ I DEDUCTIDNS i CHAN(~ ORDERS 4~'PROVED IN I I I PftEVI0U5 t~1THS AY OI~IER I I I I I I Af~RUVED THIS M~INTH I I i I I I 1~4AER I DATE F~PkOVED I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I I . I I i I TOTF~S I 1 I ~ I I I I~T ~ 1 I I BY qi~ OKDEkS I I I 1 I I The undersigned Cantractor certifies that to the best of the Contractor's knoNledge, infor~ation and 6elief the MorN covered by this Appliration for Pay~ent ha5 been co~pleted in accordance Mith the Contract Docu~ent5, that all a~ounts have been paid by the Contrartar for work for which previous Certificates for Pay~ent Here issued and pay~ents received fro~ the ~vner, and that current pay~ent shown herein i5 now due. (~WTkACTDR: By: Date: ORIGIPUaL (bPITRACT S1~4 518, 579. N@ NET f:HRI~E BY (~f(~IGE ORDERS CONTRACT SUM TO DATE 518,579.0@ TOTAL C(~4PLETED ~1D STORED TO DATE 21 B, 209. Q~N AETA I Nf~ : 5.0X of Co~pleted Work 218,209.Q~ 5.0X of 5tored Material Total Retainage 1@,918.45 TOTFY. EARNED LE5S RETAII~ ~@7, 298. 55 LESS PREUIOLIS CERTIFICATES OF PAYP~EtVT 177, 232. ~ CUkf~NT S~ES TAX: 8.~+x of Taxable A~ount Current 5ales Tax CURf~NT PAYN~NT Dl~ 3A,Nb6.~5.5 ~ ~Z~$ ~~~~ ~ ¢ ¢Q w ~ ~ J g Q z m ~a~o a ~n z ~>->-~o °Q~~~ ~Z~~ ~ ~l. BAL 0 FINISH, It~LUDI RETAI ~ 31 ,280.45 f L~-_~- State of: ~ Z Caunty of: ~>~~Z~1~ Subsrribed and orn to befare ~e this~~~ day ofG~"_/ ,199~ My Conission expires: ~_ G~_ ~ ARCHITECT'S CtRTIFICATE FOR PAYh~NT In accordance Hith the Contra~t Docu~ents, based on on-site observations and the data co~prising the above application the Architect certifies to the tl~mer that to the best of the Rrchitect's knowledge, infar~ation and belief the Work has ~qresaed as indicated, the quality of the Work is in rdance Hith the Contract Docu~ents, and the Contractor '~"`entitled to pay~ent of the AMOIpJT CtRTIFIED. F~AJT CERTIFIED f ARCHITECT: C,(~~c~„- u.Pk,~c~P ~ ~-~'`{~ v By: Date: -, /-~~ ---- - --~~~G~~ - _.1 This Certification is not negotiable. The ~OUNT CERTIFIED is payable only to the Contra~tor na~ed herein. Issuance, pay~ent and acceptance of pay~ent are Nithout prejudice to any rights of the Owner or Contractor~ under this Contrart.