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Hrr~~~:A~yN AND CERTIFICATION FOR PAYMENT ------,= TO OWNER: City of Eugene ZIO Cheshire Ave. Eugene, OR 97401 FROM CONTRACTOR: 2G Inc., dba 2G Construction PO Box 11735 Eugene, OR 97440 CONTRACT FOR: DOCUMENT G702 1 of 2 ~V~P PROJECT: ' Eugene Depot Art Base ~„~' 433 Willamette St. ~ ~ Eugene, OR 97401 ~ ,\ VIA ARCHITECT: ~~ ~j Pivot Architectnr~ - ~ ~ ,- 72 W. Broadway Eugene, OR 97401 ~~~•4~.~`'°~ CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM $ 11,814.00 2. Net change by Change Orders $ 0.00 3. CONTRACT SUM TO DATI (Line 1 + 2) $ 11,814.00 4. TOTAL COMPLETED & STORED TO DATE $ 8,860.50 (Column G on G703) 5. RETAINAGE: a. %a of Completed Work (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) $ 443.03 0.00 443,03 6. TOTAL EARNED LESS RETAINAGE $ 8,417,48 (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) $ 0.00 8. CURRENT PAYMENT DUE $ 8,417.48 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 3,396.53 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS _ _ _ -T~ changes approved - -- in revious months b Owner Total a roved this Month TOTALS $0.00 $0 ~ NET CHANGES b Chan e Order ~TION NO: 1 Revised TO: 06/30/06 NOS: CONTRACT DATE: Distribution to: OWNER ARCHITECT CONTRACTOR 07-18-pbP12:4z RCVp 2006 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. CONTRACTOR: 2G Inc., dba 2G Construction By. - r ~---~ Date: 07/12/06 Vickie Ingfam, Controller State of: Oregon County of Lane Subscribed and sworn to before me this 12th day of July, 2006 _ OFFICIAL SEAL w: ',, STEFAN! A. MYERS Notary Public: ~.. ~~ ~ NOTARY PUBLIC -OREGON My Commission expires. 0/04/07 COMMISSION N0.371960 MY COMMISSION EXPIRES OCT. 4, 2007 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Cortract 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. ~ \. AMOUNT CERTIFIED .. ..... $$T~ ~~ (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application amf orrthe G'~'ttinuatiorr 3heerthttt are changed to conform with the amount certified.) ARCHITE T: i By. Date: This Certificate is not negotiable. The AMO CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment aze without prejudice to any rights of the Owner or Contractor under this Contract. --. .. - ,,,,. ~~~~•,~ ~y-r~rnYmtnl 1992 FALTlOD1 AIA.. gygg2 __- _ _ Users may obtain validation of this tlocument try requeaong a complMetl AIA Document D401 - Certihcabon of Document's Authenticitlr from the UcenaaE Ri€ ARAERtCAN tK ~~ ~ t `° Z O ~ ~~~-~ ~ t370YilOf!