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APPLIL'ATION AND CERTIFICATE FDR RA`fMENT TO i~lNER) : MARIUN COIJNTY IN@ HI6H ST. NE SALEM, OR 97310 rRUM lCC~NTRACfORi: STATDN CONSTkUCTION, INC ~9s'94-A Airport koad Eugene„ t7R 974A~-9594 F~NON~ #: f541> 461-N543 CHA~v~ ~ C~N,DER SUMMRRI` PROJECT: MARIDN CO/SALEM/DEMO ~20 HIGH ST. SALEM, UR 9731~ UTA lARCHITECT7: tdTRACT FOR: I AI~Di i?QP;~ I CEUUCTIQNS I C;-!HtdG~ ORDER~ AE'F'Rilb'EU IN I I I F'Rtt~IDUc ~':1~JTHS P,Y C~W~JER I I I _ I 1 I f~RGUED iHIS M~NTH I I I I I I WI~MRER I DATE Ar~F~HOVED I I I I I i I I I I I I I I I I I i I I I I I I I i I I 1 I I _ _I I I I TUTALS I I ~ '~' I I I NET CHANGE I I I AY LtIAN6E OkDERS I I I I I I The undersigned Contrartor certifies that to the best of the Cantractor's knowledge, infor~ation and belief the work covered by this Application for Gay~ent has been co~pleted in accordance with the Contract Docurents, that all a~ounts have been paid by the Contractor for -vork for ahich previaus Certificates for Pay~ent Here issued and payeents received fro~ the Owner, and that current pay~ent shawn herein is now due. COPIT kACTU ~ ,~r AY~ ~ ~ ~~~ Date: rr~/Z~ /~G~ - ----------- -Ul_ 1 _ ARCHITECT'5 CERTIFICATE FUR PAYh~NT In accordance with the Contract Docu~ents, ba5ed on on-site observations and the data corprising the above application the Architect certifies to the Owner that to the best of the Architect's knoHledq_e, infor~ation and belief the Nork has pr ~sed as indicated, the quality of the Mlork is in ac.~,,,an~e Nith the Contract Uocu~ents, and the Contractor is entitled to pay~ent of the AMOU~lT CERTIFIED. PAGE 1 GPPLICATION N0: 7 DATE @8/21/97 F'ERIO- T0: F18/cl/97 ARCHITECT'S PROJECT N0: CONTRACT DATE: ORI6I~J~L COtdTFACT 5U~ td~T CHAfJC~E A`r` GHAtvG~ Ohi~R~ CO~VTk~T SUM TO D~TE TDTAL COMPLETED AND STORED TQ DATE RETAItdAGE: 5.0% af Coapleted Work 518,579.@0 5.e~ of Stored Material Total Retainaqe TOTAL EAR1dED LESS RETAI~dA6E LE5S PREUIOIIS CERTIFICATES DF PAYMENT CllRRENT SALES TAX: ~.Q~X af Taxable A~aunt Current Sales Tax CURRENT PAYp~NT DIIE 9ALANCE Ts ~I~SH~,~IP~LUDING RETAINfl6E I L~~7~1"C/~~/ t~. ~~. ~if. `Ib, 5i9. @P JIA~ J%a. ~'~e 518, 579. ~d~ c5,9c8.95 49~, 6~. ~5 458,679.8@ 33, 971. ~ 25.928.95 ~ ~ I ~ ~~~ ~ ~ ~~q~w ; cn vZ°~ ~ ~ mz + ~a~~~ ~ ~ a~z t~ ~->- cn o oU ~~ j z°c4~ I ~~~~ ~~ 5tate of: ~r~e,qon County f: ~~ ~~~ Subscribed and s-vnrn to before ~e this ~`~4 day of~sf;149`] My Conission expires: (~-L{ q9 f~I~IT CERTIFIED t ARCHITECT: RY~ Oate: This Certifiration is not negotiable. The I~R~fT CERTIFIm is paya6le only to the Contr-~actor na~ed herein, Issuance, pay~ent and acceptance of pay~ent are Hithout prejudice to any rights of the Owner or Contractor under this Contrart.