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APP~TION AND CERTIFICATE FOR PAYM ' AiA DocvMENT G~oa ~~ns~N~t~o~ on ~~~ S~d~ P~~E o`` F PAGES ~ TO OWNER: Marion Co. & Salem Area Transit Attn: John Whittineton 3140 Del Webb Ave NE FROM CONTRACTOROR 97303-4165 Pence/Kelly Construction, Inc. PO Box 4109 Salem, OR 97302-8109 CONTRACT FOR: PROJECT: Courthouse Sauare APPLICATION NO.: Court & High Streets PERIOD TO: Salem, OR 97301 PROJECT NOS.: VIA ARCHITECT: prbuckle Costic Architects CONTRACT DATE: 363 State Street Sa1em, OR 97301-3533 9900600020 . Distribution to: 8/31/00 ~'~~ER' 99-006 ~+C7 ARCHITECT ~l CONTRACTOR 2/17/99 ~ P~ - DH ~1 P/K - MS CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amouncs have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- ment eceived from t wner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . t ~ Q dto dQd nn CONT OR: P nce y Construction, Inc. 2 . Net change by Change Orders . . . . . . . . . . . . . . . t ~ ~nn ~~~ nn 3. CONTRACT SUM TO DATE (Line 1 t 2) •....... t ~n ~so ~sn nn By: Dace: 8/29/00 ~- . 4. TOTAL COMPLETED & STORED TO DATE ...... E ~n ~ n~ S~A nn (Column G on G703) • RETAINAGE: a. ~,,gg% of Completed Work E n nn (Columns D + E on G703) b. ~d% of Stored Material t n nn (Column F on G703) Total Retainage (Line 5a + 5b or TotalinColumnIofG703)•••••••••••••••••s nnn 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . t ~n i n ~ S~A nn (Linc 4 less Line 5 Toral) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certlflcate) . . . . . . . . . . . . . . . . . t 1 R,97~, ~~ ~ nn 8 . CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . t 1,128,351.00 9. BALANCE TO FINISH, INCLUDINC~i RETAINAGE (Line 3 less Line 6) E 558.172.00 CHANGE ORDER SUMMARY ?iDDITIONS DEDUCTIONS Total changes approv~d in previous months by Owner 2,215,072.00 -14,806.0 Total approvcd this Month TOTALS . ~ • " ~ • NET CHANGES b Change Order 2,200,266.00 State of: pregon County of: Marion Subscribed and sworn to before me this 29~ d y o Au OFFICIAL SEAL MATTHEVIP L SMITH ' NOTARY PUBLIC - ORE(i0N Notary Public: ' COMMISSION N0. 303013 My Commission acpires: July 14, 2001 MY COMMISSION [XPIRES JULY t4, 2001 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising this application, the Architect cenifles to the Owner chat co the best of the Architcct's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with thc Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t (Attach explanation if amount certdfied differs jrom the amount applied jor. Initial all ftgures on this Applfcat pn and on the Continuatfon Sheet that are changed to conform to the amount certifted.) ARCHITECT: Arbuckle Costic Architects By: Date: This Certiflcate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUAAENT 0702 ~ APPLIGTION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIAo • m1992 • THE AMERICAIV IN5fl7'UTE OF ARCHITECI'S, 1735 NEW YORK AVENUE, N.W., WpSHINGTON, D.C. 2000fr5292 • WARNINQ: UnIIClrls6d phOtOCOpylllg VIOIt~tRB U.S. Copyl'Ight leWS end wltl subJect the vloletor to legel proaecutlon. GTOZ-1992