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Sent by: STATON CONSTRUCTION 1 541 461 0545; 10/22/97 2:45PM;,J~ #242;Page 4/5 <br />Ai~ICATIaN AND CERTIFtCATE FOR PAYl~EriT P~(~E l <br />TU SOLS1E-i? : 4n1AIt~f ~lTY Pf~1JECT: llRfllOF! CQ/SRf.E!!!D~lD APDLICAT[ON N0: 28 ~11E 10/23197 <br />188 Hi6H S1. !~ 2P8 HI6H ST. <br />SACEM, DR 97a10 <br />Ff~1 (CflNTf~iEiORf : STATON I~WS3RUCTItIN, INC. <br />~9394-8 A~rport Road <br />Eugene„ tIR 97~-82-9544 <br />FH~tJ~ #t t~411 451-A543 <br />PERIOD T0: I0123t47 <br />SALfpJ, [tR 97328 <br />Ai~1iTECT~ 5 <br />VIA tARCHITECTt: PRDJfCT N0: <br />COriTRACT F4~t: <br />CF~iTRACT DRTE: <br />CHAN[~ tiF~9ER SUP1ltRRY <br />f MQITi[~ i DEDt1C'fIEM6 f <br />i~#~16E t1R0ERS APPROUED IN I 1 1 <br />PfikUIUUS MON3F#i BY O~iFER I <br />f 81s816.08 i f <br />I 1 <br /> <br />{~+Yi~1VED TMiS I~H { <br />I ! I <br />I 1 <br /> <br />l~k I DA7E RPAfiWED t <br />i t k <br />! i <br />t <br />~ f 18i2~197 1 <br />I 1 <br />! { <br />I I 2~69~. M! 1 <br />i ( <br />! I <br />I I <br />! ! <br />i 1 <br />I I I I <br />1 1 <br />f i <br />TOTA~S 1 <br />1 ~.595.88 f i <br />f i <br /> <br />iYET CtiW+16E 1 ! f <br />BY Ct~ I~IERS { <br />i 93~ 72I. 8B I I <br />1 I <br />me uc~dersigned Contr~ctor crrtifies that to tht tttst of ti~e <br />Contractar}s knowledge, infar~a#zan and helief the ~ork <br />covered Dy this iipplicatian for Pay~e~ has been ca~letcd <br />irt ac~cordance ~ith the Contract Docwents, that all a~ounts <br />have heert paid by the Contractor for rrorN for ~-irh prlvlDUs <br />Lertificates far µay~er~# ~rere issued and pay~en#s reeeived <br />fra~ the Owrte~~ and tAat current pay~ent shv-m herein zs na~r <br />due. <br />8y: ~~ Date: +U _ a~ r1'1 <br />~ , ~~`~ a ~r~ <br />ORI6I-IRL C[~TRACT 5t~1 518. 579. QO <br />~T c~6E AY C~ o~uERS $3 ~ 711.08 <br />(~JNTRACT Stkt TO DAfE 682,298.08 <br />TQTAL C~IPLE7@ f~IQ 5101~ TQ DRTE 6~, 240. 88 <br />REiAI~iGE: <br />~C of Coipleted Work <br />5.(d% of 5tortd Materiat <br />Tota~ Retair~age <br />TOFAL EA(~ L.fSS RE~f RIt~ b82~ ~9~. @8 ~ <br /> ~~~ a <br />IESS Pi~YIEIUS t~~RT1FICaTES OF PAYI~EMT 57~, t75.58 ~~ <br /> ~~ <br /> <br />CURHENT Sfll.ES Ti~1l: ~ <br />U7~~~~~2 <br />~ u~ _ ~ <br />? <br />cS <br />SQ <br /> <br />8.8@~c of Taxa6le Mount , <br />~ <br />~~r~$~ <br />c.~ U~ 2~, , <br /> dF-~y <br />~~~3~ <br />Current Sales Tait ~ <br /> ~ <br />CllRRENT PFYMEt1T 1~lE 30, 214. 50 <br />SF~ANCE T~,,£I~(ISN, IfIC1UDIN~..(lET~11~E L ~ '`°~"~ ' <br />5tate of: ~,~1.Q_~C~~ Caunty of: ~~_Q,.t"t_2_ <br />Subscribed ~nd 3NOrn to titfOre ~e this~~~dap ofL7~'f 1997 <br />Ny Ca~ission ex~ires: Cv-~/ s?y <br />t~t~if;1EGPS CER7I~FCATE ~tlR PRYMENI <br />in accordance Kith the tiontrxt Oocwents, ~sed ors on-site <br />oDseraatians artd tlse data ca~prisirt9 the above applicatiort <br />tAe ArMitect certifias ta tt~e Ormer that ta tt-e best of the <br />Archite~t's Nnowled~~, rnfar~atiQn ~-d bel:et tbe YQrk has <br />pragressed is in0icated; the qui2ity of the iiark is in <br />ac~ardance rith the Centract Docusents, and the Gantractor <br />is entitled to piyient cf the iU~iNT CEATiFIED. <br />AMO~lT LERTIfIED <br />At~HIT~CT: ~~~hS~~- ~L~~ <br />v <br />6y ~~~_~~/2.~-.,,~ Date: ~a- 2 Z-~ <br />~=~ <br />This Crrtifuation is Aot segvtia0le. 7be R~OUIt7 [~HTIFIED 25 <br />payaDle aniy to the Eontractw^ rta~ed herein. Issuince~ piY+tent <br />and accrptance of pay~ent are N~tbout pre~udice to any rights <br />of the OMmer or Cuntractor under this C~ntract. <br />~ ~ _~ ~' l~C~ ~~ <br />~- ,~t,~{.~'C._ Y'~li ~ ~, ~.~. 7~t . <br />w~~~2..~i,r f ~ ~ ~ t. o :~-r ~~.~' <br />e~ <br />~~~~~~~ <br />7 <br />~C, N `~ <br />,~o ~z ~= / ~~ <br />