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APPL~..ATION AND CERTIFICATE FOR PAYM ~. ~' AIA DOCUMENT G702 (Instructions on rcverse side) PAGE (,F PAGES TO OWNER: M~~ Co. 8t Salem Area Transit Attn: John Whittington 3140 Del Webb Ave NE Salem, OR 97303-4165 FROM CONTRACTOR: P~~elly Construction, Inc. PO Box 4109 Salem, OR 97302-8109 CONTRACT FOR: PROJECT: Courthouse Square VIA ARCHITECT: ~~ckleCosticArchitects 363 State Street Salem, OR 9~301-3533 APPLICATION NO.: 9~~2 PERIOD TO: 4/30/99 PROJECT NOS.: 99~ CONTRACT DATE: 2/17/99 Distribution to: ~ OWNER ^ ARCHITECT ~] CONTRACTOR $] P/K - DH %7 P/K - A/R CONTRACTOR'S APPLICATION FOR PAYMENT Appiication is made for payinent, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . E 18.459.484.00 2 . Net change by Change Orders . . . . . . . . . . . . . . . E 24~942.00 3 . CONTRACT SUM .TO DATE (Line i t 2) • • • • • , • • E 18,484,426.00 4. TOTAL COMRLETED & STORED TO DATE ...... E 346~619.00 _ (Column G on G703) . 5. RETAINAG : ~?~ii3l.b a.~ % of Comple~ed Work E -~g6.~9'_ (Columns D + E on G703) b. ~•~'/o of Stored Material E 0.00 (Column F on G703) Total Retainage (Line Sa + Sb or 17~33~. a+ Tocal in Column I of G703) . . . . . . . . . . . . . . . . . E 1~ ~~..-Q~ 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . E 329_3~00 (Line 4 less Line 5 Toral) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 froin prior Certificate) . . . . . . . . . . . . . . . . . E 108,803.00_ 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . E 220,538:00 9. BALANCE TO FINISH, INCLUDING RETAINAGF g 155 ~~.00 (Line 3 less Line 6) E 1~ ~ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS NET CHANGES by Change Order S24 942.00 The undersigned Contractor cer~ifies that co the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documencs, chat ali amounts have been paid by the Contractor for Wor~pr whlch previous Certi~cates for Payment were issued and pay- ments received fr~m the Owner, and that current payment shown herein is now due. CON By: ~~c /,~~~,/ ~G,_ ~ Date: 4/2g State of: pregon County of: Marion Subscribed and sworn to before me this 28th day f April-99 Notary Public: My Commission expires: July 14, 2001 OFFICIAL SEAL ;, A9A`~THEW !. S~IOTH NOTARY PUBLIC - OREGON GOl~°dISS10N N0. 3~3613 MY CQ!~#RISSION ~XPIR[S JULY 14, 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 certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f ??~ ~~5_-a (Attach explanation ff amount certified dijfers from the amount applied for. Initia! a1! ffgures on this Applicatfon and on the Continuation Sheet that are changed to conform to tbe a ount ce :fied.) ARCHITECT: By; _ Date: ~ This C ot negotiable. The AMOUNT CERTIFIED is payable on y 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 OOCUMENT G702 • APPLIGTION AND CERTIFiCATE FOR PAYMENT • 1992 EDITION • AIA~ •~01992 • THE AMERIGN INSTITUTE OF ARCHI'CECTS, 1735 NEW YORK ~`'Ri'~ ~ AvENUE, N~C. ~unSHINGTON, DC. 2000G5292 • WARNINO: Untlcensed photocopying violates U.S. copyright laws and witl subject the vlotator to legal prosecution. G702-~992 ,, r~~ re~ inN• vn~, ahc,~~ld use nn orialnal AIA document which has this caution prfnted ~n red. An original assures that changes will not be obscured as may occur when documents are reproduced.