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f~'aLICAfIOM AN- CERfIFICATE FOR PAYh~NT (0 tt~II~R) : MARION COUNTY 1~ H I GH Sl . NE SALEM, OR 9731@ :„:: FRI~q t(~]NTRACTOA) : STATON t~ISTRIICTION, INC. 29394-B Airport Raad Eugene„ DR 97402-9594 ~INE #: f~41) 461-@~4s' PROJECT: MARIUN CO/5ALEM/~ 22~ HI6H ST. S(~tl~, DR 97310 VIA IARCHITECT): CCINTRACT FOR: CH/~ DkDER SUMlMAKY I Ct~lu'E 012DtIi~ APPROVED IN I Pf(EUI[~15 M[~IlHS RY DWNER I ADDIII(Ml5 I DEDUCTIDNS I I I I I i i Fd~kUVED TH1S MUNTH I I I~MFsEk I ~TE F~GHUUED I I I I I I 1 I ~ I ~ I I ~ I i i iu-r~.s i I t~T CHANGE I BY [~E DkDERS I ORIGIt~L CUPfTRACT 51~1 NET CH~J6E AY CHF~J6E ORDER5 CO~tTR4~T SUM TU DATE RA6E 1 F~PLICATIfk~l P~: 6 DATE 88/@4/97 PERIOD T0: @8/04/97 ARCHITECT'S PR0IECT N0: CONTRf~T DATE: ~ I TOTAL CUPIPLETED FYJD STORED TO ~iTE I I I I RETAINR6E: I I ~ ~ S.Q~X Df CD~pleted Work 482,82@.80 I I I I 5.@X of 5tored Material 1 I ~ ~ Total Retainage I I ~ I TDTF~ EARNED LESS RETAIP~E I I ~ ~ LESS PREVIm1S CERTIFICATES OF PAYWENT I I ~ I CUkf~NT S~ES TAX: ~ ~ N.@Q~X of Taxable A~ount The under5igned Contractor certifies that to the best of the Contractor~s knoNledge, infor~ation and belief the Nork covered by this Application for Pay~ent has been co~pleted in accordance with the Contract Docu~ents, that all a~ount5 have been paid by the Contractor for Nork for rd}ich previous Certificates for Pay~ent Here issued and pay~ents received fro~ the (hm er, and that current pay~ent shoNn herein is noa due. C[~il kA(:TUK: BY• , _ ~~~ Date: 8~ Current Sales Tax CUkI~NT PAYt~NT Ql~ 518, 579. Q~@ 518,579.Q~ 482, 82@. N0 24,141. ~ ~ 458,679.~ ~ z ~g _~~ ~ ~ 332, 988. 77 ~ ~ Q ~ ow ~ ~'c>z~ -' z~u 0 ~ O u] c..~ - LL n.tnZ LL~'~~%O O()~~~n Qf 4~N ~ `~~ 2 F"'~ O U ~ ~ 125, ~9@. 23 ~'~?;~. ~ `} BAL 0 FINIBFI, INCL t~ I 9, 9~. Q~ ' ~ , -~ State of: ~LQ~~/Z.J County of: ~~ Subscribed and sw rn to before ~e this /~~'f day ofQ,~l~~1997 My Co~~15510T1 expires: ~_y~Q Ahh~iITECT'S CERTIFIt~1TE FUR PAYI~NT In accordance Nith the Contract Docu~ents, based on on-site ob5ervations and the data co~prising the above application the Architect certifies to the tlMmer that to the best of the Architect's knowledge, infor~ation and belief the Work has proqressed as indicated, the quality of the WorN is in ~ 'ance Nith the Contract Docu~ents, and the Contractor i~citled to pay~ent of the AhIOU~IT CERTIFIED, AM~LINT CERTIFIED f AR[~IITECT: ('~t~C~ (,(,Q~ ~iy~ . ~~ 4 aY~ ~.2L~.~~ . ~1n.r,~ Date: ~, ~ ~ This Certification is not negotiable. The AM~LA~IT RTIFIED is payable only to the Contractor na~ed herein. Issuance, pay~ent and acceptance of pay~ent are Nithout prejudice to any rights of the ONner or Contractor under this Contract.