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APPLIC;~?TION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE oNe OF PAGes TO OWNER City of Eugene PROJECT: City of Eugene APPLICATION NO: 6 Distribution to: Facility Management Division Amazon Ball Field Restroom QOWNER 210 Cheshire Ave. Q and Lighting Replacement .ARCHITECT Eu ene Or 97401 PERIOD TO: 02/25/04 QCONTR.ACTOR g, ~ o FROM CONTRACTOR: VIA ARCHITECT: WBGS Architecture Colberg Commercial, Inc 72 West Broadway 1310 Coburg Road, Suite 10 Eugene, Or 97401 PROJECT NOS: 313.00 Eugene, Or 97401 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT Theur?dersignedContractor.certitiesthattothebestofweContraotor'slrnowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached. - 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 paym s no~ IAL SEAL S`o , ICAR~B~ L: WAL~'Ei~ NOTARY PUBLIC -OREGON 1. ORIGINAL CONTRACT SUM - $ 358,731.00 ' 2. Net change by Change Orders $ 1,781.00 CO TO COMMISSION N0.347856 3. CONTRACT. SUM TO DATE (Line 1 f 2) $ 360,512.00 MY COMMiSSiON EXPIlR11ES AUGUST 10; 2005 4. TOTAL COMPLETED & STORED TO $ 302,566.00 Date. ~ V DATE . ' (Column G on G703) By: V 5. RETAINAGE: a. 5 % of Completed Work $ 15,128.00 S of: County of: Column D + E on G703) Subsen an bef me 's day of b. % of Stored Material $ Notary Pub ' v~ (Column F on G703) My Commission ices: _ Total Retainage (Lines Sa+ Sb or ~ © S Total in Column I of G703) $ 15,128.00 6. TOTAL EARNED LESS RETAINAGE $ 287,438.00 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 Less Line S Total) ~ comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) $ 263,213.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE $ is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FIlVISH, INCLUDING RETAINAGE $ 73,074.00 ~ (Line 31ess Line 6) AMOUNT CERTIFFIED , $ (Attach ezplanati if amount cert~ed dyers from the amount applied. Initial all figures on this Totat changes approved Application the Continuation Sheet that are changed to conform with the amount certified.) in revious months b Owner $1,781.00 ARCHITE - Total roved this Month By: Date: ~ TOTALS $1,781.00 $0.00 This a is notnegotiable. The AMOUNT CERTIFIED is payable onl to the Con r named herein. Issuance, payment and acceptance of payment are without NET CHANGES by Change Order $1,781.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 • APPLICATION AND CERTIFICATION FOR PAYMENT • 1992 EbITION • AIA®• Q 1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE., N.W., WASHINGTON, DC 20008=8292 Usen3may obtain validation of this document by requesting a completed AIA Document D401 - Certlflcation of Document's Authenticity from the Licensee. oLU ~ ` D V a. l .