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Sent by: STATON CONSTRUCTION 1 541 461 0545; 10l22/97 2:44PM;,/~ #242;Page 215 <br />_~- -- - <br />APDLICATIEIN aND CERTIFICATF FQR PAYMEN7 PA~ ! <br />Tt] 4(~IER): l~iRION C,OtlefTY RR41fCT: MqRIt~IV Ca/~LfJ+IlOEl1p fiAPLtEflTiQFi N0: 4 DATE t8/~J97 <br />108 ifIGH S7. NE 2i8 NI6H ST. <br />SFKErl~ OR 9731~D <br />~~EIP! {CONNiAACTDA! : STATtIN CE~VSTRIiCTIOM~ II~. <br />29394-8 Airpart Rnad <br />Eugene„ UR 974~2-9594 <br />PHOt~ #: t54~? 461-0`.~43 <br />D~RI~ I0: 10t~i97 <br />SAt~~1, QR 97s10 <br />ARaiI IECP S <br />VIA {AAEffITECT?: PRQ]ECi H0: <br />C~iTRRCT FOR: <br />CW~ITRACT DAT~: <br />CFIHN6f URt)ER SE1l~lfiRY ORT6I~iL CUHTRAGT SUN ~1$r 579.00 <br />I AQAI'iiOMS I UEDItTIt1N,5 ! <br />t~lAN6E IfRi)E~iS f~PR4Vf~ 1N f ! I <br />PREUit1US DlONTNS BY ~R I <br />I 81, @16. 08 1 I <br />I I <br />puDRUVEp THFS MUNTH I ! I <br />1 <br />titlMBtR t DATE ~t11 l 1 I <br />1 I <br />I 1 <br />2 I 1~122l9i 1 <br />I i <br />I E <br />I I <br />1 I <br />! i <br />I I 1 ! <br />2,695.88 ! t <br />I f <br />I I <br />I I <br />f f <br />i I <br />f I <br />TOTAt.S f <br />i E, 645. ~8 I t <br />I I <br />Ai~T t~ i I 1 <br />BY Ck~E OiiDERS i <br />! 8'ss 7I 1. 88 I I <br />I I <br />TAt wndersiyned Co~t#r~Mor Ctrtifies tbat to the Qest Bf the <br />I:ontractor'f knowledgP, infor~ation artd belief the ~ork <br />caverrs! by this t~pliCdtton for Pay~er-t has been Co~pieted <br />in ~eordance pi~h the Contract ~ocu~ea#s, that alI atounts <br />have bern paid by the Cantra~tor for work for Nhich previc~s <br />Certificates for Pay~ent Nere ~ssued artd pay~rnt5 received <br />{ro~ the Ormer. ind that curreat pay=enL sham herrirt is nOM <br />due. <br />8~ ~/~~.,~.'y: Date: ~~ -aa ~l <br />T ~~L 1 ~ ~ <br />NE1' CF~N6E BY f~1A1~6E Ot~AS 83, 711.08 <br />E~R~T ~1 TD QATE 68c,248.88 <br />TQiiit. COI~LETED ANE1 STOAED TO DATE b~, 298. 8B <br />AETAIf~: <br />5.8x of Capletrd fiork ~~_75 <br />5.(~t of 5tcred Materiai <br />Total Retatnage 38~t14.58 <br />TOTpl. EAftNED t,ESS RETAit~ 572,175. 58 ~ <br /> t_ y .. <br />" <br />~ <br />LESS PREVItIl1S t~RTIFICA'!ES UF PR~!!z 569,615.25 3 <br />~~„ ~ <br />~ ~'~ ,; ~ <br />~ <br /> ~ G:' <br />; ' ~ ,; <br /> <br /> <br />CURRENT SRI.FS TAX: v, . ~ ?.. ~ <br />}~: .~:. <br />a ~ - <br />=" <br /> ~ ~i <br />:'~ <br /> <br /> <br />~.0~ic cf raxable s~rount ~ ~.' ~,, _ ~ <br />.~. >• . . <; <br />° _= «: ; ~.s <br /> tr,- _ > <.,J <br />~~';~;- <br /> <br />Current 9ales Tax f <br />}` ~ 2; • <br />i <br /> <br />EURRF~+lT PAYI~M DUE ~, 5b0. 33 <br />~;; ~ <br />~ <br />t <br />~,}~ <br /> ~ <br />TD FINISH, I#~IN6 lEq6E , l 14.58 <br />~' ~ __ ~ <br />---. <br />Stite of: ~ <br />Co~t <br />of: ~~ <br />r <br />Qy~ <br />y <br />Subscribed and <br />~rn to btfare fr this''~C~day af~L1",19~1 `( <br />My Co~~issian expires: (.,Q-y ~t7 <br />W~IAiIT CERTI~IED ; <br />i~NIIECf~S CfRTiFiCAT~ Fpp PAYMQIT <br />in accordancr Mith tne C~ntract Oacu~eats, ~7d5Bd On Oil-sitr <br />abservations aaM the data co~prising the aDove applicatien <br />the f~hitect certifies ta tAe t~mer that to the best of the <br />Ar¢t-itect's hna~ledget inlar~atian and brlief tAe Nork has <br />progressed as indicated, the quality of #he iiorM is in <br />acccrd~nce rith the Contract aocu~ents, aad thr Contractor <br />is entitled ta pay~ent af th~- AMElE1NT E~RTiFiED. <br />Aiiatl TECT: ~'L.~~~ <br />BY ~E~~ ~t ~ate: `~~U~~,.``I 7 <br />This Cert3ficition is not negatiatrle. The f~JNT CERTIFYED is <br />paya~le oniy tu the Cantr~ctor na~rd herein. lss~tance, ~ay~ent <br />and acrrptarme of paYElrit are Mittto~t prejudtCt t0 any rlghtS <br />of tht Urmer or Cantractor under this Contract. <br />~ ,~-~,~i~t ~ Y^~.u i ~C~ ~ ~~ ~1 ~ , (,~- u / <br />~ f'r' a~,y ~sc.c~r ~' f~ ~-'~ ~ ~ r>-~.~- <br />a. ~+ ~ ~ <br />~~~~ <br />1~h~1~~ <br />