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JC~iI Uy. JIHIVIV ~,VIVJIfSUI.IlUIV <br />AaALICATION AND CERiIfj(~TE FQR PAYMENT <br />TO IONNER) : MARION COIN~ITY <br />108 H1GFf Si, NE <br />SAi.E1l, OR 9731~ <br />FstflM ICONTt~CTD~#t : STATtkV CQ~ISIRIICTION, INC. <br />2934k-B Airport Road <br />Eugene„ tiR 97482-g5g4 <br />~~ ~: ~541? 4b1-B`.~43 <br />CHW~6f URDER SUI~iHY <br />~ ADDli'IONS I DEDlGTIOM.S 1 <br />G~IrEE DRDEIiS f~PROVED IN I I I <br />pAEVIQUS M~1THS BY ~R i 81,@ib.BO 1 ~ <br />~ ~ I <br />AuPRGVED THIS t~LWTH f ~~T'~ <br />f ~ I <br />lit~StR I DATE F~PKOvED ! <br />I I I <br />~ <br />~ I 18122/9i I <br />I ~ <br />~ f <br />I ~ ~ ~ <br />2,695.88 I ~ <br />~ ~ <br />~ ~ <br />~ ~ <br />~ ~ <br />~ ~ <br />I ~ <br />T8TAL5 t <br />~ f ~ <br />k ~ <br />~ ~ <br />2T645.08 I ~ <br />~ I <br />I <br />" NET ~ I ,_~ <br />I I <br />BY Cf~ pf~DfRS t <br />~_.. 8's,7i1.88 i ~ <br />_.__~ I <br />~~4i 4b~ U5a5; 1U/11/y/ Z:44NM;~X ~#242;Page 2/5 <br />~ I <br />PR0IFGT: MARI~1 t~/SALEJ~V~Ip APPLIEATIOH N0: 9 DAIE 10/~/97 <br />228 HI6H ST. <br />SA[-Flf, {1R 97,3ld <br />D~RI00 T0: i0/2~/47 <br />VIA lARC~IIfECT}: <br />CaVTRACT Ft}A: <br />Tht undersigned Corttrdctor ctrtifies that to the best of tAe <br />Contractor'S kno~ledge, iofor~ation and trelief the -ark <br />covered by this ~p~lCitlOn for Pay~ent has been corpfeted <br />in ~cordance kith the Contract OocuEeots, that all a~ounts <br />have brrrt p=id by the Contractcr for --ork for ~hich prrviaus <br />Lertificates for Pay~ent Mere issued and pay~ents rereived <br />tro~ the OMntr~ ind that ccsmnt payrent sham her~irt is noM <br />due. <br />[S3!(1 RACIDk: <br />gY~ ~1~~~.~_ .~f~ Date: <br />- ~ ~ -aa q'1 <br />ARCHlTECT~S CER7IFI(~2TE FOA PpYME?1T <br />in accordance Kith tne Contract Doru~ents, based an an-sitr <br />abservations and the data co~prisirtg the atrave application <br />the f~itect certifics ta the tT~mer that to the 6est af the <br />Rrchi#ect's knaNledge~ lnfarsation and brlief tAe Nork has <br />progressed as inCicated, the quality of the Work is in <br />aceordtnce ~ith the Gontract Oocuaents, aAd tht Cantractar <br />is tled to pareent ot tAe APlE1fA~(T E~RTIFiED. <br />ARCHIIECT'S <br />PR~J~I t~q: <br />CWdTRACT bAT~: <br />~RT6Ir~. CUNTRRGT St~l SZ8.579.00 <br />I~1" C~ Bv Cl~ QR~RS 83.711.08 <br />COK1'RACT SUM TD DAiE 682,~98.s8 <br />TOTHL COMPt.ETED At~D ST(IRED 1'0 DATE b82, 290.8$ <br />RETAINA6E: <br />5.0x of Coip}eted Work I34.75 <br />S.BX of Stared Material <br />Total Retainage 38,I14,50 <br />TOTAL EARNED LE5S RET~INA~ 5T~,175. 58 ~; <br /> <br /> <br />LfSS RitEVIOUS CEKfIFIC~iTES OF PRYMEttT 564~615.25 r_y _. <br />Z~~, ~-~' <br />C7~;'~ "i <br /> " -. <br />~+~:,; <br />CURRENT S~I.FS IR7I: > <br />, <br />"s- .'<•: <br />~ `= r ~> <br />. <br />: : <br />~ <br /> - <br />. <br />: <br />ci il -, •,:~j <br />8.0B~c af raxable s~rount o~`` ~' `' ~ <br />L` ~~: ; ;,; <br /> <br /> <br />Cwrent Sales T~t ~:-a~„ ~ <br />Cr~: "=; <br />ti `'~ '; <br />2; . <br />EURRQ~lT PAYI~EM Dl& <br />2, 560. 33 ~ 2 ~ <br />~• , <br /> +~~ , <br /> <br />TD fINISH, I~t1DIN6 AIt~ifiE 114.50 <br />' ' !~ :r `f. <br />j <br />~ _ 1 <br />State of: ~ ~y Coimty of: l~-~-~ ~-~- <br />Su6scribed and~rn t before ^e this'~C~da <br />af~~' <br />14`~ `1 <br />y <br />My Co~rission expires: (.,Q-y ~~ , <br />Rh~JHT CFATIFIED : <br />AF~3f1 TECT: G~Zd~' <br />BY Date: !~ - r~~~'~7 ~ <br />Thij Cert~tic~tion is not negetiatrle. 7he AM~Ni (~RTIFj~p iF <br />payable Cniy ta the Cantr~or nared herein. Issuattce, paytent <br />and accrptancr of paqseAt are ~it~tout pre~uC~ct to arry ri~ts <br />af the OMner ar CanLracter under this Cantrart. <br />