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A~ . LICATION AND CERTIFICATE FOR PA~..~ENT AIA DOCUMENT G702 Instructions on reverse side ~YnGE ONE F ( ~ O PAGES TO OWNER: M~~ Co. 8t SalemArea Transit PROJECT: Courthouse Square APPLICATION NO.: 9~~2 Distribution to: Attn: John Whittington PERIOD TO: 4/30/99 X] OWNER 3140 Del WebbAveNE PROJECT NOS.: 99-006 ^ ARCHITECT Salem, OR 97303-4165 $] CONTRACTOR FROM CONTRACTOR: P~~Kelly Const~uction,lnc. VIA ARCHITECT: ~~1de Costic Architects CONTRACT DATE: 2/17/99 $] P/K - DH PO Bax 4109 363 State 3treet Salem, OR 97302-8109 3alem, OR 97301-3533 ~ P~ _~ CONTRACT FOR: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Con[ractor's knowledge, infor- mation and belief the Work covered by chis 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 amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Wor r which previous Certificates for Payment were issued and pay- ments received fr m the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . t 18,459,484.00 CON R: ` 2 . Net change by Change Orders . . . . . . . . . . . . . . . E 24.942.00 ~ ~ , 3 . CONTRACT SUM TO DATE (Line 1 t 2) . . . . . . . . ~ 18~48~426.00 By: \i /~,nn ~/ ~, \ Dace: 4 . TOTAL COMPLETED & STORED TO DATE . . . . . . ~ 346.619.00 (Column G on G703) . 5. RETAINAG : I~,rj3~,.e a.~ • /o of Completed Work ~ -1~66:99' (Columns D + E on G703) b. ~•~'/a of Stored Material t 0.00 (Column F on G703) Total Retainage (Line Sa + Sb or 17~33~. a. Total in Column I of G703) • . . . . . . . . . . . . . . . . t _ 6 . TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . ~ 329,~00 (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) . . . . . . . . . . . . . . . . . .~ 108.803.00 8 . CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . r S - 220,538:00 9. BALANCE TO FINISH, INCLUDING RETAINAGE 18 t38 155 ~ 00 , (Line 3 less Line 6) E , . CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Totai approved this Month TOTALS NET CHANGES by Change Order S24 942.00 State of: Oiegon County of: MBtipn Subscribed and sworn to before me this 28th day f A '1-99 Notary Public: ~ My Commission expires: July 14, 2001 OFFICIAL SEAL AAA`iTHEN! L S~AETFi NOTARY PUBLIC - ORE(i0N CC~~I~IISSION N0. 3~J3013 MY CO!~~91SSION EX?iRES 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 knowiedge, 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8_ ~_ ~~_~'A~J~..e (Attach explanation if amount certified differs from the amount applied for. Initia! al[ figures on this Application and on the Continuation Sheet that are changed to conform to the a ount ce tJied.) ARCHITECT: BY~ Date: _~~~r" 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 DOCUMENT G702 • ApPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA~ •~01992 • THE AMERICAN fNSTITUTE OF ARCHITECI'S, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 2o0oCr5292 • WARNING: Untlcensed photocopying vlolates U.S. copyright laws and wiil sub~ect the vlolator to tegal prosecution. G702-1992 is, ~ ,i ~ CAUTION: You should use an original AIA document which has this caution prlnted fn red. An originai assures that changes will not be obscured as may occur when documenta are reproduced.