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APPLICATION AND CERTIFICATION FOR PAYMENT TO CONTRACTOR: MERRILL CONTRACTORS, INC. 3205 NE 78th St., Suite 10 Vancouver, WA 98665 FROM SUBCONTRACTOR: PROJECT: APPLICATION NO: PAGE ONE OF TWO PERIOD TO: VIA ARCHITECT: PROJECT #: SUBCONTRACT FOR: CONTRACT DATE: SUBCONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. 1. ORIGINAL SUBCONTRACT SUM 2. Net change by APPROVED Change Orders 3. SUBCONTRACT SUM TO DATE (Line 1±2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on Page 2) 5 MoreI also certify that payments, less application retention, have been made through the period covered by previous payments received from the subcontractor to (1) ... Less
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