New Search
TO-~_. <br />AND CERTIFICATION FOR PAYMENT <br />PROJECT: <br />City of Eugene <br />210 Cheshire Ave. <br />Eugene, OR 97401 <br />FROM CONTRACTOR: <br />2G Inc., dba 2G Construction <br />Eugene Depot Art Base <br />433 Willamette St. <br />Eugene, OR 97401 <br />VIA ARCHITECT: <br />Pivot Architecture <br />DOCUMENT G702 Page 1 of 2 <br />r ! <br />APPLICATION NO: Distribution to: <br />1 Revised OWNER <br />ARCHITECT ~ <br />PERIOD TO: 06/30/06 CONTRACTOR <br />PO Box 11735 72 W. Broadway PROJECT NOS: ^ <br />Eugene, OR 97440 Eugene, OR 97401 <br />CONTRACT FOR: <br />CONTRACT DATE: May 9, 2006 <br />CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and <br />Application is made for payment, as shown below, in connection with [he Contract. belief the Work covered by this Application for Payment has been completed in accordance with the <br />Continuation Sheet, AIA Document G703, is attached. Contract Documents, that at] amounts have been paid by the Contractor for Work for which previous <br />Certificates for Payment were issued and payments received from the Owner, and that current payment <br />shown herein is now due. <br />1. ORIGINAL CONTRACT SUM $ 11,814.00 <br />2. Net change by Change Orders $ 0.00 <br />3. CONTRACT SUM TO DATI{Line I +2) $ 11,814.00 <br />4. TOTAL COMPLETED & STORED TO DATE $ 8,860.50 <br />(Column G on G703) <br />5. RETAINAGE: <br />a. % of Completed Work $ 443.03 <br />(Column D + E on G703) <br />b. % of Stored Material $ 0.00 <br />(Column F on G703) <br />Total Retainage (Lines Sa + 56 or <br />Total in Column I of G703) $ 443.03 <br />6. TOTAL EARNED LESS RETAINAGE $ 8,417.48 <br />(Line 4 Less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT <br />(Line 6 from prior Certificate) $ 0.00 <br />8. CURRENT PAYMENT DUE <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) $ <br />$ 8,417.48 <br />3,396.53 <br />CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS <br />Total changes approved <br />in revious months b Owner <br />Total a roved this Month <br />TOTALS $0.00 $0.00 <br />NET CHANGES b Chan e Order <br />CONTRACTOR: 2G Inc., dba 2G Construction <br />B <br />y ~ Date: 07/12/06 <br />Vickie I am, Controller <br />State of: Oregon <br />County of: Lane <br />Subscribed and sworn to before me this 12th day of July, 2006 <br />t ~ , -. OFFICIAL SEAL <br />Notary Public: `, ~ ~ ~ a. ~ STEFAN! A, MYERS <br />~+ ~ ~ ~ NOTARY PUSLlC -OREGON <br />My Commission xpires. 0/04/07 ~ COMMISSION N0.371960 <br />MY COHfIAtSSION EXPIRES OCT. 4, 2007 <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on on-site observations and the data comprising the <br />application, the Architect certifies to the Owner that to the best of the Architect's knowledge. Q <br />information and belief the Work has progressed as indicated, the quality of the Work is in accordance <br />with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. c~ <br />AMOUNT CERTIFIED .. ........................................$ ~,_,~. ~ ~ . ~~ <br />(Attach explanation if amount certified differs from the amount applied. Initial all figures on this ~~ <br />AppTcation and on the Continuation Sheet that are changed to conform with the amount certified.) <br />ARCHIT T: ~ `J„1 <br />~ ~M <br />By" Date: ~ 3 d ~p <br />This Certificate is not negotiable. The A NT CERTIFIED is payable only to the Contractor named <br />herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or <br />Contractor under this Contract. ~ <br />ELECTRpNtC FORMAT- AtA t70 ~ A ICA RrA14Q A AYMENT ~ T592 <br />D~[f mW ~~u validatinnd~hisdarumontby saquostiay agpi._~ ~ .. THE AMERICAN INSTI E OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 <br />Me~etpe#ieeoeet- ..._ _..-_-_._-... ....-.__ <br />i~ <br />