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.t\ IMH ttMlN 1 1.(Intiiu« ih«ii»••II 1 i >n»e Shir) r vi.l ••.iitil PM.kHTOOtoNkB: QryofOrono rHC'itci.Orniiu C.ity 1 tall/PuIke and M‘. l KAfli »NNO:Disulbuiioii i<»;lEli Brown Bond South FtiMic Woiki litiililing ITKi^iD 10 1 1 OWNIKCfyittIBay.MN ISS2S PkOjlCr NO;1 1 ARfllfTFCTTrtOII OOMTRACrOB: Jaiiaco CmiBibig VUARanTECT:Boar man Kioot PlisterTZ2 North Seccuid Siren C ONTRACT aATE 1 1 CONTRACTORMtnnea|H>lii, MN .S40IOONTBACT FORCONTRACTOR'S APWJCATION FOR PAYMENT <br />ApplIcftikMi li Md€ for hifnicfii, u ihotm bclo^ tn cooneciiun «»uh the CuniiAci (k>niimiAiU>n Sheet. <br />AlA DociMiefii G70S. to otuched <br />I OBiCINALOONmCTSUM <br />t N m (hM|< by OtMige Otdctk <br />COMTVACT SUM TU IMTt (H im I b 2).... <br />TOTAL OmPLKTtD fc 5TOUO TO DAT! <br />RETAINACL <br />A.olC^pleted W«Mk <br />(CohmmDhiomCJOS) <br />of Siored Maierlsl <br />(Coium f on O705) <br />Total leiatoMigc (line %a It SB or <br />To«l Itt C oH mio I of C70S»>»« »• •«-••• •• •••« « <br />total IABNU) LISS be TAlNAC;r. <br />(Lliit IlcilUiii ITuial) <br />Lramviaus cunncATts fob paymzkt ._ <br />(tJM B toolo prior OriMWoie) <br />f <br />ClIBBEICT PAYMIKT DUE • ••• •• •« »•«•••«• <br />BALANCE TO nNIStl. n.US ItrTAINAr.I <br />(U m S Icm U im 6) <br />RlIUSTTRBSliTnSHAiY ADOmoNS <br />pre^ao Mta <br />Upproa ti 'JCUmX' <br />ToiohiJunrxBzr’« Order! <br />3,950 00 <br />5,70200 <br />9,652 00 <br />9,65200 <br />9,652 00 <br />1 JJSOSO -96M! <br />hrDUcTK>NS <br />The underlined Cunir acioi cenines itut to the best of die CuntrAcu>i*§ kn«»idedge. <br />Inforn^aiion and belief the ^Voik cmered by thii AppUraiU»n for Payment has been <br />completed in acccHdaiue *«uh the C^>ntfan IhM iimentt. that all amounts have been <br />paid by the Csmirador fi»r Work fi»r which pievioua Oriiricatet f»K Payment seere <br />issued and payments received (tom the Owner, and that current payment shotvn <br />herein It now due. <br />CONTRACTOR; Jaiiacu Caulkinf* <br />Dare: <br />State of: <br />ta>uniy of; <br />Subaaibed and fivurn to befuir <br />ma this day ol <br />Notary Ptiblic: <br />My Commission eipires <br />ARCHITECrS CERTinCATE FOR PAYMENT <br />til accordance with the Ton tract Ducuments. baaed on on-die obaervatium and the <br />data comprising the altove appHcaiion. the Architect ceritflei to the Osmer that <o the <br />l»est of the Ate hisec i‘i kii**«»ttdgf, lri(«M inatloo 4ii<l l»riief the W<*ck haa |»f ogrcsied at <br />Indicated, die equality of die Work Is In accoidaiue tmh the (a>nuact iJocumenia. and <br />the Contractor It entitled to payment td the AMOirNT CIKflMl ll <br />AMOUNT (iM nnti)._____ <br />(AUm< $ asp/anaeion »/ mmaunl ttfitfud dtfftn f>om Ikt mmmtmi mpfhmi fm Mitiaf <br />aE/igurct an ifu A^umtwn mkd m tkg C^mtinu^itm AA mI rial are ikmmgut la <br />tm tkt ana«inl tmUfitd f <br />ARUirffCI <br />Date <br />I Ins Cer life ate is rwn negcniable The AifOUNf CilRriHlD it payable only to the <br />CAintractof named herein IsBoaiice. payfrieni and a<re|Ma<ue <»f |jayiftrni are wiifHMii <br />prejudice to any iigliitof dtc Owner or Cisniiacior under thitCAmiraci <br />n *amj(ArioM Aim txtniKAii iv»i pAiMl*ei •ivvi tt*rrioN«AU*imi*t la amirkan tNi? nuii ui ASt jtn tc\ % 1715 niw njta avtwuf nw <br />BC fHiAMIf * WtBSnNGs t3Wik«aBM rwiMai ti A ca^fttgAc Inm »«a vSi mA^M iA b tSatMH Is ls§ai G7u2^1M