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APRLICATIOP~ ANU CERTIFICATE FOR ~AYMENT ...f <br />GAGE i <br />T4 tOWNER~: ~ARIDN CQllNT't ~RDJECT: MAAI~N COiSALEM/DEMO APF'LICATIOr~ N0: t DATE ~fii13/97 <br />i0~ HIGH ST. PJE t2~ HIGH ST. <br />PERI~~ T0: ~5l31l97 <br />fiALEM, 4R 97310 SALEM, OR 97's10 <br />ARCHITECT'S <br />fR~M {CaNTRACTORi: STATQN CONSTRUCTIODJ, ING. VIA IARCHITECT): PR~IECT td0: <br />c9~94-A Airport Road <br />C~+ITRACT DATE: <br />Eugene„ ~R 9740C-9~94 <br />PHQNE #: (541? 461-Q~~4s' CDMTRACT FOR: <br />CH~1N6E DRflER 5UM~IARY ORI6IN~. CONTRACT Slp~! ~18, 579. Q~S <br />I ADDITIONS I DEDI~TI~IS I <br />CHANGE OR-ERS APPRQVED IN I I I <br />GREUIOUS MONTHS AY DWNER I 1 ~ <br />f ! I <br />ANF~ROVED THIS MDNTH i I I <br />1 I I <br />t+H.fMRER I DATE AGGROVED I 1 I <br />1 i f I <br />I I I I <br />{ I I I <br />I f I I <br />I i i I <br />I I I I <br />I I i { <br />I I I I <br />TQTALS 1 I I <br />I { I <br />NET CHANGE I I I <br />AY CHANGE DR~ER5 I I { <br />I I I <br />The undersigned Cantractar certifies that to the best of the <br />Contractor's knowledge, infarratian and belief the work <br />cavered by this Application for Rayient has been co~pleted <br />in accordance with the Contract Docusents, that all a~owts <br />have been paid ~y the Gontractar for work fnr which previous <br />Certificates for Ray~ent were issued and payeents received <br />frof the Owner, and that current pay~ent shown herein is now <br />due. <br />CDNTRACTDA: <br />By: ~ ~ ~Datee G /~3/9 7 <br />------------------- ---~~-'- ---.~ ____-- <br />NET CHANGE BY Gi#iF~ ORIlERS <br />CDNTRACT SUM TO DATE <br />TDTAL C~IPLETED AND STORED TO ~ATE <br />RETAINA6E: <br />~.~% af Co~pleted Work 61,785.00 <br />5.0% af Stared Material <br />Totai Retainage <br />TOTAL EARNED LESS RETAINA6E <br />LE55 PREVIOU5 CERTIFICATES OF PAYMENT <br />CUARENT SALES TAIt: <br />~.idf~% af Taxable A~ount <br />Current 5ales Tax <br />Cl1RRENT GAYP~NT Dl~ <br />BAL~CE TD FINI5H, INC~UDING RETAII~C~E <br />518, 579. 0N <br />61, 78 ;. ~4~ <br />3, 089. 25 <br />58, E~95. 75 <br />58, 695. 75 <br />4~9, 88s". ~5 <br />State of: ~,~ EC~~r~ Co nty of: l--~J7~ <br />Subscribed and sworn to 6efore ~e this j,~~ day a <br />My Cowdi~aion expires: (~~ 9 9 <br />I~MOUNT CERTIFIED i <br />ARCHITECT'S CERTIFICATE FOR RAYMENT <br />In accordance with the Contract D4cu~ents, ~ased on an-$ite <br />ubser•vations and the data ca~prising the above application <br />the Architect certifies to the Owner that to the hest nf the <br />Architect's knawledge, infor~atian and belief the Work ha~ <br />progressed as indicated, the quality of the Work ia in <br />accardance with the Cnntract Docu~BiltS! and the Contractar <br />is entitled to pay,ent af the AMOUNT CERTIFIfD. <br />ARCHITECT: <br />By: Date: <br />I ~ <br />~o"$ <br />~~~ <br />~~Q~~ <br />~3~g~ <br />~a~a~ <br />~~}~~ <br />oUg~~ <br />~g8 <br />~I <br />This Certification is nat negotiahle. The AR~1NT CERTIFIED i5 <br />payable only to the Contractor naeed herein. Issuance, payient <br />and acceptance of pay~ent are without prejudice to any rights <br />of the Owner or Contractar under this Contract. ~ ~,~~`# <br />'~~'- c~. o N o'Z~ ~Gc.~ ~ `~ ~' r' a j Zc. ou' c <br />s~~. S;~,~ -~,,, 9 a~f Lo c,.,..'7'`7 ~ ro J`~.~'f' <br />l i~ i S ol~ -{-~ ~~--'t'L• v>: z~t. ~~~ h.Cr-'~ o~S' <br />#~~.9-~~R- S'tt'G~rrt'- c.._ L a s-L~^s. ~~.. <br />~~~~, blzvf~~ <br />