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~-rruc:A flc,~v AND CERTIFICATION FOR PAYMENT TO OWNER: ~'` - PROJECT: ~3' e€.1 _ . _. 216 Cheshire Ave. Eugene, OR 97401 FROM CONTRACTOR: 2G Inc., dba 2G Construction Eugene Depot AitBase 433 Willamette St. Eugene, OR 97401 VIA ARCHITECT: Pivot Architecture IOCLTMENT G702 Page 1 of 2 APPLICATION NO: Distribution to: -. 3 OWNER. ARCHITECT PERIOD TO: 10/31/06 CONTRACTOR PO Box 11735 72 W. Broadway PROJECT NOS: ^ Eugene, OR 97440 Eugene, OR 97401 CONTRACT FOR: - CONTRACT DATE: Ma 9, 2006 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet, AIA Document G703, is attached. Contract D tha 1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATI (Line 1 + 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. % of Completed Work $ p,Op (Column D + E on G703) b. % of Stored Material (Column F on G703) Total Retainage (Lines Sa + Sb or Total in Column I of G703) ocuments, tall amounts have been pard by the Contractor for Work for which previous Certificates for Payment were issued and payments received from thener, and that current payment/ ~7 shown herein is now due. ~ L7i./~!C~, ~ /'~(]~6 _I .._. ~.~.y..,_-.._ MJ ' .L~a~ $ 11,814.00 ~ ii $ 0.00 CONTRACTOR: 2G Inc., dba 2G Construction ~~'~~'~ ~~...~ _I. ~--t~ ~ - -- $ 11,814.00 a ~~3~ i ~ 1~~}.1a. $ 11,814.00 .., - ~,_.-~ By. 3~ate:r#/06 . Vic a Ingram, Controller ~ ~/` ~, `~ Z State of: Oregon V ~n ~~ County of: Lane Subscribed and sworn to before me this 19th day of October, 2006 .e ~..~..~--• - - - 0.00 $ 0.00 $ 11,814.00 6. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ $ 10,792.48 $ 1,021.53 0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in revious months b Owner Total a roved this Month TOTALS $0.00 $0.00 NET CHANGES b Chan a Order ` .-. OFFICIAL SEAL ,t.. STEFANI A. MYERS Notary Public: ~ ~`~' ~ L ~ NOTARY PUBLIC -OREGON COMMISSION NO, 371960 My Commission a fires: 04/07 ~r COMMISSION EXPIRES OCT. 4, 2007 ARCHITECT'S CERTIFICATE FOR PAYMENZ Tn accordance with the Contract Documents, based on on-site observations and the data comprising the application, the Architect certifies to the Owner that to the best of the Architect's knowledge. information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. ~ N AMOUNT CERTIFIED .. ........................................$T 7~ ~ • -~ (Attach explanrttion if amount certified di,~`ers from the amount applied. Initial all figures on this \~ Application and on the Continuation Sheet that are changed to conform with the amount certified.) ~ ARC T: By' Date: I d This rtificate is not negotiable. The AM CERTIFIED is payable only to the Contractor named ~,,, herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. Q ELECTRONIC FORMAT -AIA DOCUMENT G702 • APPLICATION AND CERTIFICATION F R PAYMENT • 1992 EDITION •AIA • 01992 Users may obtain validation of this dxument hY mquest{ng a eompleteA AIA Document D401 - Cardacedon of Documents Authentlclry from the LJeMleet THE AMERICAN INSTITUTE OE ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-6292 G702.1992 r - ~•