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• "g <br />RPRLICATION AND'CERTIFICATE F~R PAYMENT <br />OkI6INAL CONTRACT SUM <br />~u ttx~H): MRRION [~ITY <br />10Q+ H16N 51. NE <br />SALEM, OR 97s1a <br />FROM ICONTRACTQR) : TATON CONSTRtJCTIDtd, INC. <br />4-A Airport Road <br />Eugene, ~R 974~-9594 <br />f~-10l~ #: !`,411 4E @~43 <br />CF~1hU~~E OHDER S~1ARY <br />I ADDIT NS I D~DUCTIONS I <br />CHANGE C1NDEkS t~ROVtD IN I I ~ <br />PREVIUUS Mff~ITHS AY OWt~H I <br />I 81, a16. ~b0 I <br /> <br />F~PKOVED THIS t~NTH I I I <br />I ~ <br />I I ~ <br />NUMAER I OATE F~ROVED I <br />~ I 1 <br />I <br />1 I @9/il/97 I <br />I 1 <br />~ ~ <br />I I I ~ <br />2,71~.Q~8 I I <br />I I <br />I <br />I I <br />I ~ <br />I ~ <br />~ ~ ~ ~ <br />~ ~ <br />I I <br />TDTALS I <br />I 2, 70b. 08 I I <br />I <br />~ <br />t~T ~ I ~ <br />I i <br />BY [~6E UHI?ERS I <br />~ 83, 72~. 08 I I <br />, . <br />PROJECT: MARI~V CO/SALEM/DEMO <br />2~k~1 HI6hl ST. <br />SALEM, ~R 97311d <br />VIA (ARCHITECTJ: <br />C~VTRACT FOR: <br />The undersigned Contractor rertifies that to the best of the <br />Cantractor's knoNledge, infor~atian and 6elief the wark <br />covered by this Appliration for Rayeent has been co~pleted <br />in acrordance Hith the Contract Docu~ents, that all a~aunts <br />have heen paid by the Contractor for~ worN for which previou <br />Certificates for Pay~ent were issued and pay~ents received <br />fro~ the OHner, and that current payoent shoan herein is aw <br />due. <br />C(~~l RACTUR ~ <br />(~ <br />~Y:~~~~~~~~~--`'~~~~~~~~ __ Date: 9//~_ <br />Atit:HITECT' S CERTIFICATE FUR GAYMENT <br />In accordance Nith the Contract Docu~ents 6ased on an-site <br />observations and the data co~prising th above application <br />the Architect rertifies to the Uwner~ at to the best of the <br />Architect's knowledge, infor~ation d belief the Work has <br />pr~°~^essed as indicated, the qual' y nf the Nork is in <br />a ance Hith the Contract D u~ents, and the Cantractar <br />is"4htitled to pay~ent of th ~T CERTIFIED. <br />NET CHAN6E bY CFIAtJ6E ORDERS <br />RA('E 1 <br />~e~, sai. e~a <br />CONTRACT SUM TO DATE ~,@~~ 3k11, ~g <br />TDTf~ CL~IPLETED AND Sl01tED 0 DATE 6@2, ~1. 08 <br />RETAINAGE: <br />X of Co~pleted ~i6rk bN~, 301. Q~8 <br />X of 5tored ~(aterial <br />Total Retai <br />TOTRL EA LE5S RETAIPIAGE 6~2, ~I. Q8 ~ <br /> ~ <br />~ <br />SS VIDUS CERTIFICATE5 OF PAYMfEPJT 492,650.05 C <br />7~~ <br />~ <br /> Q¢ . <br />~ ~ <br />~ <br />CU Sf~E5 TAX : ~ <br />g <br />og <br />a <br />.@@X af axable A~ount ~ <br />~ <br />o a~~~ <br /> ~ <br />g~ <br />Current Sales Tax F <br />- <br />~ <br /> ~ <br />CURRENT PAYP~NT D 109,651.0s' <br />. <br />BALANCE~F~NISH, I L!D NG R~T~It~E _~ ~ ~y <br />State of: ~(~~~ County of~: G~~(Z,Q~ <br />Subscribed and SM 1"Tl to before e this /~-day of~p~',19q7 <br />P4y Co~~issi4n expires: ~- ~- <br />4~MlT CERTIFIED <br />ARCHITECT: <br />By ~ `-' ~_.G_~ ------------- Dat e : <br />This Certification is not negotiable, The AMOUNT TIFIED is <br />payable only to the Contractor na~ed herein. Issuanc pay~ent <br />and acceptance of pay~ent are Hithout prejudice to any ights <br />of the 0-vner or Contractor under this Contract. <br />~~ ~ ~~~ <br />F1f~LICATIDN N0: 8 DATE 0 1/97 <br />F'ERI~D T0: B9/11/97 <br />ARCHITECT'S <br />PkOJECT N0: <br />CONTRACT DATE: <br />