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. < A t.K i iFfCA FK I . i\il r .Al\ IKK.UMINI itlii'l (liitirtM-iions on rrvrfw iUle)pAr.roNi OF r\GfsTOOWHUI; UiyUofBoISSI ifiMm load Souih GryiiAtBiF.MN S5S2SFlOMOONTlKACnrOlLOONHACTPOI:M«l C«a Cooilniciloa PROJKTVUARairrECT:Orono Ci:x IUll/rulk:« Public Woikt Building,A1*1*IJ< AIION NOTEKion ro PROJECr NO.:a^hrntAcr hate l>mtibution lo: r~| OWNERI I ARclirrEc.T r~| CONTRACTORCONTRACTOR'S APPUCATION FOR PAYKfENTAppttcailoa It made for Paymeiu, at thotm below, in connei lion %dih the Cuiitrict 0>riiuiUiitofi Sheci. <br />AlA Document CTOS, b attached. <br />1 ORIGINAL OONmCTSUKL 54.500.00 <br />Net dtugt bf OiHigc Otd«r»»•»•••« •• •« •«« »« •«•••«• ♦•••••• ••• •••«•*••«(77.47) <br />% CO»nRACrSUMTOI>ATl(UnclA2,•• •• ••• ••••»••••••••«•••54.42253 <br />The underdgned Conirant>r ceriiriet ihti to the best of the (4»niftcior*t knowtrdge. information and belief the VVoik cciveied by this Application for Pa)rment hat been completed in actordance with the Contract Docurnemt, tliat all aniounu have been <br />paid by the (a»ntractor for Work for which previout Certificatet for Payment %«rre <br />Istued and payriienit received from the Owner, and tlut current |>ayinent ihowii <br />herein It now due. <br />CONFRACroR; Mel Con C«ns!ruci|ofl <br />Date. <br />TOTAL OOMPtmO IrTTOREDTO DATE...54.12253 <br />RtTAlNAGE. <br />a.of Gomptfted Work <br />(Colymn D li t on CTQS) <br />ol Stored Material <br />(Cohmi Fun CTOS) <br />Tolid Reudfiage (Une %a li SB or <br />Toiil la ColiMia 1 of CTOS). <br />Sutc of: <br />County of: <br />Siibacflbed and ivM»rn to befoie <br />ma this day of <br />Notary Public: <br />My CiEmmiiiion fipiret <br />i TOTAL EARNED LESS RETAINACL. <br />(Una lloaliac ITotal) <br />T LESS PREVIOUS ClRTinCATES FOR PAYMENT <br />fUat i from prior CertUkau) <br />54.42253 <br />47,77800 <br />• CURRIKT rAVMEKT DUI <br />RALANCI TO nNISH. ELUS RFTAINAr.E <br />(Um SIcmUm A) <br />l).044 53 <br />ARailTECT'S CERTinCATE FOR PAYMENT <br />In acc(»rdance %dth the C^nirac i IKk urnenii, bated on on frie obtervationt and the <br />dau comptitirig the above application, the Arcbiieci cettifiet to the Owner that to the <br />bea of the Architect't knowledge. lnforma*U»n and belief the Work hat progretted at <br />indkaird. the rpaiiiy of the Woik It in accordance with the Conuact Documenu. aad <br />the Conuactew it eniiilcd to payment of ilie AXIOUNT CERTIFIED <br />AMOUNE CFR nniJ).......................................................... I <br />(AtimiM tfipfanarian ^ mmtmtni c. fi/ud dtffmt ftmm tkt mm0%tnl mffdttd fm. huitmi <br />•f fiptrm m tkti wnd m lA« £k«t lEof era cSenyd le <br />tamfmm U tk$ mmmuni tmUfktd.) <br />pwieir^^ <br />i^iaff&iefiippfmWia <br />ADOmONS <br />pfmdomi by owacr <br />idndoiMh <br />To3t <br />DEDtlCriONS ARCTirrECT: <br />Date <br />Thu Ccrufcaic U aoi negoe able The AMOUNT CERTUIEU b payabk only to the <br />Comractor named herein ImuaiKC. payment and acceptance of payment are withom <br />prejudice to any righu of the Owner or Cociiraciui under ihb Conuact <br />« •AffucnTiONAHOMrmQkTiroRPAViiurTMfii ti>fTi«tN*AU*iwfnMi AktiRicANbOTnintof ARairrtcTi. imfawvuRRAVtwutNw <br />sc IRUUm • WARlIVtCai V a Ww« Mt -« MifM Ik* wkmirnm n bgW |GVniWl