Financial- Staton Construction - Laserfiche WebLink

Home Browse Search

~ ' . APF~t.ICATII~d AND CERTIFICATE FOR PAYt~NT .`, TO {OkN~Efi> : MtaRIi]N C~Il'Y 1~ HII~I Sl. NE S~1LEM, OR 9731@ Ftt~l tGONTRt~T4R): 5TATll~f C~ISTRUCiIUN, IN~. 29394-A Airport Road PRDJECT: MARIOht CQISALER!/DEp~ 220 HI6'ti ST. 5t~EM, flR 97310 UTA ~ARGHITEGT): Eugene„ UR 9741a2-9544 PHdt~ #: i~411 461-0543 C~ITRACT FOR: ,,,,d PAGE 1 i~LICATIDN N0: 4 DATE 07/04/47 RERIOD T0: 07/04/97 ARCHITECT'S ,~5~ ~ RRQ,IECT N0: ~ ~ CONTRF~T DATE: ~ ~ ~`~ CHAI~ DHDER 5Uh~1ARY I ADDITIDNS I llEDI~TI~ I CHi~IGE DRDERS AGPROVED IN I I i PktUI~JS pl[~ITHS BY 04A~R I I 1 1 1 I ~+AUVED THI5 p~NTH I I i I 1 I M~tAER I DATE ~PkDUED I I I 1 1 I I I f I I I I I I f I 1 I I I I I I I i I I I I 1 I I I I TOTALS 1 I 1 I I I NET CHANGE I I f BY CH~ OkDEkS I I I ~ ~ ~ The undersigned Contractor certifies that to the best of the Cantractor'~ knowledge, infor~ation end belief the work covered by this Application for Pay~ent has been co~pleted in accordance with the Gontract Docu~enta, that all a~DUDtS have been paid by the Contractor for work far ~hich previous Certificates far Pay~ent were issued and pay~ents received fro~ the Owner, and that current pay~ent shawn herein is now due. CDNTkf~TDR: 8y: Date: DRIGII~. CO~ITRACT 5'~i NET CHAt~`iE BY Ct~GE OR~RS CONTRi~T SlM9 TD ~TE TOT~ C~ETEI1 AND STD(tED TD DATE RETAINAGE: 5.@% of Co~pleted Work 218,209.Q~ 5.0% of 5tored l4aterial Tntal Retainage TOTF~. EARt~D LES5 RETRIt~'iE LE55 PREVI0ll5 CERTIFICpTES OF PAYt~NT CUHRENT Sf~ES TAX: O.~Q+X uf Taxable A~ount Current Sales Tax CUkf~NT PAYI~NT I~JE 518, 579, ~ 518, 579. ~ 218, 2Q+9. Q~ 10,910.4~ 2A7,298.55 177,'c32.~ ~ =Z~g ~~~~ ~ ~ ¢q w ~~ Jg~ Z V~~~~ a~Z O~Q~O Q~~"' ~Z~g ~ 30,866.55 . f~ J~~. BAt. FINISH, INCLUD RETAI ~ 31 ,~8@.45 ~ ~ .. .. _._.._. State af: (~ Caunty of: ~>~~~~Z~ Subscribed and rn to before ~e this,3~~ day ofG~i`r~. ,199~ My Conission expires: ~_!~_~ flRCHITECT'5 CERTIFICflTE FDR PAYh~NT In accordance with the C4ntract Docu~ents, based an on-site observations and the data ca~prising the above application the Arrhitect certifie5 to ti~e Uwner that to the 6est of #he Architect's knowledge, infor~atian and belief the Work has progressed as indicated, the quality of the Wark is in accordance with the Contract Dacu~ents, and the Contractor i5 entitled to pay~ent of the AI~IT CERTIFIED. AMOLN~IT CERTIFIED f ARCHITECT: C,t~n.dGc/~.c~ ~Qx.Y ~ir~ ~~'`P U ~Y ~ ~~~ _ - _~~~ - Dat e : ~~71 ' 1_ This Certification is not negotiable. The AI~I.q~IT CERTIFIED is payable only ta the Contractor na~ed herein. Issuance, pay~ent and acceptance nf pay~ent are without prejudice to any righte of the Owner or Contractor under this Contract. ~~~~ ~ l~ 1p? .