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AF'f''LICA- <br />TO OWNER: <br />N AND CERTIFICATION FOR PAYMENT <br />City of Eugene <br />210 Cheshire Ave. <br />Eugene, OR 97401 <br />FROM CONTRACTOR: <br />2G Inc., dba 2G Construction <br />PROJECT: <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 />APPLICATION NO: Distribution to: <br />2 ~ OWNER ~ <br />^ARCHITECT <br />PERIOD TO: 08131/06CONTRACTOR <br />^ s <br />PO Box 11735 72 W. Broadway <br />Eugene, OR 97440 PROJECT NOS: <br />CONTRACT FOR: Eugene, OR 97401 <br />CONTRACTOR'S APPLICATION FOR PAYMENT CONTRACT DATE: Ma 9, 2006 <br />Application is made for payment, as shown below, in connection with the Contract. The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and <br />Continuation Sheet, AIA Document G703, is attached. belief the Work covered by this Application for Payment has been corn leted in don <br />1. ORIGINAL CONTRACT SUM <br />2. Net change by Change Orders <br />3. CONTRACT SUM TO DATI (Line 1 + 2) <br />4. TOTAL COMPLETED & STORED TO DATE <br />(Column G on G703) <br />5. RETAINAGE: <br />a. % of Completed Work $ 568.03 <br />(Column D + E on G703) <br />b• % of Stored Material $ 0.00 <br />(Column F on G703) <br />Total Retainage (Lines 5a + Sb or <br />Total in Column I of G703) <br />6. TOTAL EARNED LESS RETAINAGE <br />(Line 4 Less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT <br />(Line 6 from prior Certificate} <br />Contract Documents, that all amounts have been paid by the Contractor for Work for which previous <br />Certificates for Payment were issued and payments received fmm the Owner, and that current payment <br />shown herein is now due. <br />$ 11,814.00 G-C.yQ~ l ~0 ~//7 <br />$ 0.0o CONTRACTOR: 2G Inc., dba 2G Construction ~~~ 20 ~ '7' ` <br />$ 11,814.00 <br />$ 11,360.50 ~"~~ ~~{~ ~ l„ <br />By. C 08/31/06 (J~ <br />Vi a Ingram, Controller ~ <br />State of: Oregon °`""' ~~ <br />County of: Lane <br />Subscribed and sworn to before me this 31st day of August, 2006 <br />OFFICIAL SEAL <br />/~ ~ ~ ~ • ~(} n. `_r~: STEFANI A. MYERS <br />Notary Public: ,l_L.F(,~ ~ I (~/~ f( NOTARY PUEtLIC -OREGON <br />My Commissio exp' 10/04/07 ~`" ~ COMMISSION NO. 371960 <br />$ 568.03. <br />$ 10,792.48 <br />$ 8,417.48 <br />- - -- • ° • -•~~ ~ ~~~. ~~.~ ~rn i mi Vq i iuN TOR PAYMENT .1992 EDITION • AlA . _ t992 _ <br />Users may obtain validation of this doeument b11 requestin~a comoiAr.w gtl4.peenenent li•Qt ~ -~ <br />..-. .----- -- -Cer6iicdaon of tlocumanYa Authenticity from UW U, <br />a ~a <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, G1 <br />information and behef the Work has progressed as indicated, the quality of the Work is in accordance o~O V, <br />with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. <br />~`'" ``` <br />AMOUNT CERTIFIED .. ,~ N <br />~,.. >... <br />~t <br />{Attach explanation if amount certified differs from the amount applied. htitiat att figures on this c <br />Application and on the Continuation Sheet that are changed to conform with the amount certified.) <br />ARCHITECT: <br />By. Date: O <br />~ g l~ .~. <br />This Certificate is not negotiable. The AMO 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 Q <br />Contractor under this Contract. <br />09-22-Ob AOb~17 IN <br />G702-1992 <br />8. CURRENT PAYMENT DUE $ 2,375.00 <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) $ 1,021.53 <br />