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t~ICATIQPI i~VD CERTIFICATE FOR PAYp~NT ~_._, CO~fTRACT DATE. TO {~R? : t~IR1~1 COL~ITY PRDJECT: I~RIOPI CA/Sf~EM/DEM~ t~PI.ICATIOM I~: 3 ~TE ~/27/97 1{d0 HI6H 5T. t~ 'c20 HIGFI ST. S~EM, OR 9731@ FR(~I tCQNTRACTDR) : 5TATDM (~NSTALJCTI~I, IP1C. 29394-8 Rirport Road Eugene„ DR 97482-45g4 P'F~ ~: {541f 461-0543 PERIDD T0: 06/27/47 5At.EM, OR 97310 ARCHITECT'S VIA tARCFIITECT): PROJECT N0: CD~ITRAGT FOR: CF~ ORDER ~IARY I ADDITI~ISI DEDUCTIDN5I (~AN6E ORDERS i~ROVED IN 1 I I PREVIOUS MONTHS BY ~IER I I 1 i I I AF'PROVED THIS lI~ITH I I I I I I 1~A~48ER I DATE APP'ROVED I I I I I I I I 1 { I 1 1 { I I I I I 1 I I I I I I I I I i 1 I I I I TOTf~.S I I i I I I I~T [~16E I I I BY CHF~ DRDERS I I I I I 1 The undersigned Cantractor certifies that to the best of the Gontractor's knoHledge, infor~ation and belief the Nork covered by this Application for Pay~ent has been co~pleted in accordance with the Contract Docu~ents, that all a~ount5 have heen paid by the Contractor for work for r~hich previous Certificates for Pay~ent were issued and pay~ents received fra~ the Owner, and that current pay~ent shown herein is now due. C~ITRACTOR: , . ay ~%~ ~'~ L~i~~::~1~2~~ Dat e.~ . ~- DRI6II~. CDNTRi~T SLM 518,579.~0 I~T CHAN~ BY CHAN6E ORDERS C~1TitflCT SUhI TO DRTE TOTF~ C~L.ETED (~NII STOAED TO DATE 518,579.~ 18b,5G8.08 t~TAII~: 5.0% of Co~pleted Work 186,568.00 5.8% of Stored Material Total Retainage TOTAI. EAI~D LE55 RETAINAfiE LESS PREVIDU5 CERTIFICATES ~ PAYl~NT CURt~NT SALE5 TAX: 0.~% of Taxable R~ount Current 5ales Tax CURAENT RAYMENT DUE f'::'c.~ 9, 328. ~ 177,P32.~ 128,569.Z0 ~., ~, rn i-- ._ Jr?~~~ t;i t,'; ~ _h ~<~~, ~~ . ;,, .,, .. _~~~ ' _"~ Gy C_ -~ `=' ' } Q ,,, _.. ; ~,r~ oU~Y°~ f~~-~v:= ~-a+Ci ~_ Ci ~ 46,662.88 6~ :;. I I5H, INCL IW~E 1, 347.00 ~ 5tate of: ~~~Q.~'~~ County af: ~QIZ.2. Subscribed and sNOrn to befnre ~e this a(a~ day ov~~'199~ My Couission expires: lo-h~ 99 AMOLN~T CERTIFIED ARCNITECT'S CERTIFICATE Ft3A RAYh~NT In accurdance Nith the Contract Docu~ents, based on on-site observatione and the data ca~prising the abave application the Architect certifies ta the DNner that to the best of the Architect's knowledge, infor~ation and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Docu~ents, and the Contractar ia entitled to pay~ent of the AI~UNT CERTIFIED. RRCHITEGT• ~~~ By:~ __-- __ Date: _ 3j~ J"'7 This Certification is not negatiable. The AM~AdT CERTIFIED is payable only to the Cnntractor na~ed herein. Iasuance, pay~ent and acceptance of pay~ent are Nithout prejudice ta any rights of the Owner or Contractor under this Contract. ~~" v ' l "7~jf~'?