ROBINSON LETTER OF TRANSMITTAL CONSTRUCTION CO. 0B: 0696 Villages of Hayden DATE: September 15, 2006 RE: PAY APPLICATION #5 To: 48 Development 120 W. Broadway Altus, OK 73521 WE ARE SENDING: ‘COPIES: DATED. 3 09/15/06 PAY APP #S PLEASE NOTE THE FOLLOWING: itted for your approval SIGNED _ 21360 NW Amberwood Drive; Hillsboro, Oregon 97124 (903) 645-8531; Fax: (503) 645-5357=o {BeNIUOD Sip epun sorgNNLO; 10 ZUNE 29 JOS nd o0'0s. 22920 2ueH 4 UE noi am wourked Jo zourndoare pu Wuatused ‘sous ita pause sor 20101 wo 98485 GALLYAD INNOMW AKL EIOEDO ES EM | OOS ‘00°0S SWi01 aed wa [ooos 0008 ‘LOALIHONY o0'0s 00'0s SoG SY {penis rows wa tm aec> 0 paloma Wa 00S wogenine 21 Wo vee 4 Uo sey ye er DaaDe OE BW LONE a INOUE a 29608'LEZ$ cain a enausio Nowy 96'999'r90'rs zeeon tees ovzee'ses'is zozes'te 1s So ‘ 2 vor'ses. oo0s trusty po 36 uno ‘ervoyens Jo-s-G ao 5 Le'96o'Rze'is o0'8s2'o6e'ss 00s (09 NOLLONUISNOD NOSNIBOY ”~WOIDVELNOD 2109) paaidin: nou St soy MONS WOUUAed woxma Yin pu ANNE 3t9 9m 1UBuNGe| 1} areD9013-)SHoUNaud KINI In] 04%, 2 now if MY. aUNDOC enNUOD ay MA 29uepI0996 u ‘Pemon ou wm vorsaunsn w nea Unois se weds fe 4 passion How 2 toy poxtooas suounsed pie EST) #2106 4 ‘OMORS TIN 0H Pefong AAG GOOMYaWY MN OgELZ oO AAMWBRY PAOLLOMUISNOD NOSNIGON — sojeqvo9 worg So sopenweg =] 9002816 a1 poveg Weste no ‘sng ewan UH AvMGYOuE M O21 ci vomnaTeG s ‘ON voaeonddy NSQAWH 40 SJOWTIIA 9690. aosioug ATTGLUNSINGO13A3O SP sung op 909690 S#2qyoauy ANAINAWd YO4 SLVOISILYSD ONY NOWWOMNddvover S90 oo gee. ‘000 on'sez 000 oo ve6'er 008 ¥ NonuL MOIS |zz05-2 eos, © merze 000 ws9u's, LL E00» oo8z9've1 BLVAVOXG MRIO1S | 0006-2 oo'wos'ss 4000 000 000 000 00'80s's3, oniavavezez evioc'es = 4ae'9 000 000 uszzs'9 00'928'rs 30v id MOON G3HSNHO| eEzez ooors'ze ures 00 ‘000 oozie'zt oozsi'sez ONAL HOY OBHSNHD| zeze-z zee = wonse 000 Socesiz — eyier'st 00's96'z01 Nolavawoxs 3x18 | a002-2 coosre == 000 000 000 ooo oo'09"'z Nownow3a so1sr'6: = woos 000 see's pr oue'eL coves'ec NOLLVZNROW LNaWaINOI trise's = 4er09 000 | seus wseso'zi 00 000'42 OOM ALIN adi cooze'es = x00 00 00 000 o0'0ze'es WaQNSM-3av9SONV arses — 0010 ooo 00 ooo ov 9e0'tes Z3NILBYW-E4IND ooves'rsz = 4000 00 ooo oo 00'¥69'ez WTB“ ONIAWE eSoz'rt = sezt's6 ev teOLUe © Ov Oszes'e —_LeeBo'uz =o 4627's62 09008 - AUYLINYS Szaon'es were SLesR'oe =o covsoe —svzea'ee 00 299'r6 09008 - uaivM Oorsrect — Ko00 a0 000 oo 00 s5y'9¢1 o008-WOLS ‘000 0000 OD EIS» 00 000 oveis'zoy NvoRNSWNOLWAWOXS, Oo'Sr'ey MIB 0 GS6'F 00 ‘00 INOW = rayon es'za6'tz 000 000 sarivannos nois3a| 39 90'8¢ 0010 000 RWNONYT “AaAUNS oogar'e 00'0 000 ‘90¥#OT09 MN “4931039 oz't28'69 000 ezooe'tt SNOILIONOS TwH3NID ooo 000 NOWLONALSNOD Sud ooo 000 ‘SNILINSNOO ONY LAM ooo 000 ASONVLS 48am NYOISWY ooo 000 MNO LLYWY NOW 000 000 WOSdO1 ainerusiaay 000 | wezee'y BONALSISENSMIOW ALUN, 00 uety epics ASAuNS NOLLWAVOXS ooo 00 ooo ‘salvannog 1809 Hons ooo 000 e960z'er TAAL ABAUNS weryl — eeess 000 00 eeess ZONMIS Oo AanHNS werge sues, 000 900 souse'L ZONNIIAaRUNS Gara Garam pasoig ona rari, t "ON yo0loud 80014214 ‘on 9002/S1/6 : a1eq uoResnddy HON woneoniddy £407 384 4133S NOLLVANILLNODSevor'as —GO'ZL'eas'¢ | KoLzE —LB'96O'RzS'E 000 SroLo'WZ — 9L-9R0'r89': —_oo'ssz's60's stei01 pur 00 ‘0000! oowe'eS GOO 000 oosze'es ooeze'es ‘viv3oNvuNsni| 000-66 sesaoust worze vO vORDS ~— 0. ugerooz 9 09902 oorss'iz -L140ue | 000-86 ossszesz © 400000 ooo 00 000 osesz's9e ADNSONILNOD | 000-26 zy'o8e WeOLs —ag'ezO'F oo ooo asez0'y oooee'y LIS Od01-34 | 002-06 000 ‘00001 og siz oo 00 oosez oosez voy x!4 | 001-06 oooo0'e = KOD!0 S00 000 00 000'0e ‘SNID33SOUGAH | 006-08 ooor'se = 400000 000 ooes'sz SONIHSINUNS 311s | 008-88 ood}. © = Ko00 00 00 0.000'01 30¥NOIS |o00-99 op000'00z © 000 = 00 ooo (00.000'002: ENSINNNOW AYLNS | 00S-¢8 Brewer = asez LORE ooo o0'08e' 98334 ¥ SLINw3d |o0e-29 0000's = 000 oo ooo 0000'S SONVMMOTIV NOISSa TH¥m O13 [002-28 ooo00z = %o00 oo ooo (00.000'2 NSW LN 3SNaNYT | OS1-28 ooo x00 = 00 000 00.000'9zz LINGNOD AL ® BNOHd| aPt-e8 ooser'ei —Ko00 000 000 00 98e'ezi 301438 SvO ost-e oooo0'sze © %oo0 000 000 00 v00'sze 2013S YaM0d |oz!-ae onoos'ese = 000-0 00 00 003'es2 4290N6 ONUHON aus |oL-ee ooo0s'2s = 000 000 ooo 00006'z SONVMOTIY NOIS3G ¥ ONS |00%-ne ooeer'ss = aves © o000' 090 ooear'sz SONiddO¥91NO 20H | 1006-2 coses's = “000 oo 000 oo 8es'a "8 0X TYM ONIN eceos'sy warez —t9'S87'6k ©0000 ooszs — Koo0 00 000 cosst’> wov0 000 090 yous Hone SALMAN auis| zz—5-2 ‘S31LMuN auIs|o0ss-2 00u 8 HONuLANYLINYS |zz~s-2 eS00ves — erISL —eSzizzz ~— 000. es w0z0z = 20S LovoR'e == 000 sevsso'ee = wee LB FL'OZS'eOL [000 on'9es's02 SLva¥voxs:AuyiNvS |ooes-2 cevesy = KONE oraz ‘ooo oveas'sr 9904 ® HONUL BaLvM| 2225-2 zeze'so! gis aoss'isz _' 00 ooese'z96 LNW? 8 SUVAVOXa NaLWM |o9es-2 Gad Gea mND puns spuasong ane, oa Sat seamen, |r ———_pagapans, won so wand rag won 1 4 a a 2 a v #010Nu soozrsu6 900ZISWE = NEG UOREONddy . ‘ON uoneandey cca 133HS NOLLVNNILNODROBINSON CONSTRUCTION CO. INTERIM LIEN / CLAIM WAIVER From: Robinson Construction Co. Contact Person: Kyle Palmer Contact Telephone: 503-645-8531 CONDITIONAL RELEASE ‘The undersigned does hereby acknowledge that ‘upon receipt by the undersigned of a check from 48 Development (name of firm writing check) im the sum of 231,809.62 and when the check has been properly ‘endorsed and has been paid by the bank upon ‘whieh it was drawn this document shall become effective to release pro tonto any and all elaims and rights of lien which the undersigned has on the above-referenced job, This release covers a progress payment for labor, services, equipment, and materials furnished and/or claims through ‘September 15, 2006 only and does not cover any retention or items furnished after that date, Before any recipient of this document relies on it, said party should verify evidence of payment to the undersigned. I CERIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THIS STATE THAT THE ABOVE IS A TRUE,AND CORRECT STATEMENT. pat oerepotetaner Ona ‘aia State of County of Subscribed and sworn before me this day of ——__20__. Notary Public _ Commission Expires: Project: Villages of Hayden Project Manager: Ryan Barackman Project Phone: UNCONDITIONAL RELEASE ‘The undersigned does hereby acknowledge that the undersigned has been paid and has received rogress payments in the sum of $__for labor, services, equipment, or materials farnished to the above referenced job and does hereby release pro Yanto any and all claims and rights of lien which the undersigned has on the above-referenced job. This release covers all payments for labor services, equipment, materials furnished , and/or claims to the above referenced job through ___. NOTICE: THIS DOCUMENT WAIVES RIGHS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP ‘THOSE RIGHTS. THIS DOCUMENT IS ENFORCABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL RELEASE FORM. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THIS STATE THAT ‘THE ABOVE IS A TRUE AND CORRECT STATEMENT. Siguatre: ities Dates (Cig. State)APPLICATION AND CERTIFICATE FOR PAYMENT 069608 Project 0596- VILLAGES OF HAYDEN ‘plication Na 7 PecodTe: 30/15/2006 CONSTRUCTIONS Aretiect: 21960 NW AMBERWOOD DRIVE Projet tes HILLSBORO OR w7124 contract For Contact oat: CONTRACTOR'S APPLICATION FOR PAYMENT ious Cerificates for Payment “hat eurtent payment shown hi '85,896,258.00, '$5,896,259.00 as $3,422,895.70 pate 10/06 any LHASA, sifniem bron. Sout leethy m4y for Pied OCS nger 2 Be 2022, OFFICIAL SEAL S171.18685 DANYELLE TYRRELL $9,251,750 84 Contes RECO ITECT'S CERTIFICATE FOR PAYMENT, SION NO. 404432 ance with be Conta Drsments bed on Osh hea MAGN EONS Ad $2,523,718 ® 872803253 $2,644,508.16 AWOUNT CERTIFIED. § 728,032.53 {ach extanatnn ¢ amount cernd ates tom he ance ste 20 ur on ts Appteston ano ine Garten Sir a a casper ara an [deducts $0.00 $0.00 ARCHITECT: $0.00 $0.00 ate 30.00 30.00 $0.00 ble. The AMOUNT CER Bl nd aceepian ner of Contractor under *728,032-F *757_ = "5UL,094.4° EAP AH MATERA, ERROR WE ROARED Te wuen Ar suOUL® Hee eer 75 SND TS OF #14 350.93 (cares REMnE) MoMERD OF 75% OF 72% 052, Apumcdd “574,762.25 , Bax Saou Hive Bee Talo oFCONTINUATION SHEET lnvoice #069608, one Contract: 0686. VILLAGES OF HAYDEN 112008 10/18/2006 Seheguted Valve Retainage SURVEY FING? |URVEY CALC FILING 2 URVEY TRAVEL 0.004) PRIOR COST BOUNDARIES 0.008] EXCAVATION SURVEY -007} 6-008] REMOVE MATL FROM W 0.000] AMERICAN WEST STANDBY 6.010] WETLAND CONSULTING (0-015 | JOHNSON RANCH POWER ITE FURNISHINGS OVER EXCAVATION TE LIGHTING POWER SERVICE PRE CONSTRUCTION GENERAL CONDITIONS GEOTECH. NW COLORADO SURVEY. LANDMARK DESIGN BOUNDARIES LANDMARK - AD) 2.200) EXCAVATION-AMERICAN 2.500] STORM-B00c0 2.601] WATER -BOOCO 2.502] SANITARY - BOOCO 2-555] GAS LINE 2.600| PAVING - ELAM 2.620| CURB-MARTINEZ 2.800] LANOSCAPE-WENDEMA 20003] PIPE & UTILITY RCC 2-1011 | EQUIPMENT MOBILIZATION 21100] DEMOLITON SE a0OTS 18,108.00 233,423.00 21,515.00, 208,070.00 26,000.00 64,928.00 48,060.00, 50,000.00 467.519.00 196,454.00 94,967.00 251,291 00 85,490.00, 294,634.00 571,036 40 53,920.00 21,000.00 38,524.00 2,460.00 6.170.00 160,840.58 0.09 000 15,107 26 7,610.00 487,519.00 0.00 85,471.58 298,539.98 0.00 0.09 0.00 000 13,209.45 24,481.69, 0.00 20,149.36 30,589.85 0.00 000 a0 1827059 00 00 0.00 0.00 61.79.63 22/861 50 482174 0.00 0.00 226,800.00 0.00 29,997 49 5,584 28 0.00 29,427.85 16.560 69) 1.14000, 2,755.00 3,060.00 5,170.00 160,840.58 20,149.36 30.58885 15,107.26 233,422 13 43,360.96 30,045.97 ‘000 100.0% 10.00% 25.27% 124.18% 100.0% 10.00% 100.0% 81.26% 64.25% 59.17% 51.08% 15.22% 100.0% 45.28% 114.22% 104.04% 59,580.64 “6.956 85 ora oer 000 1827272 8.937 80 26.509 10 23,51289 42,390 00 000 74,874.37CONTINUATION SHEET Invoice #: 969608 Cor 0696- VILLAGES OF HAYDEN ‘Application No. 4 ion Date To! Architect's Project No. Page 3 of 4 Schedules € Materias Hetainage Value Presently Stored or) (Deer) Zao Tae OAT OD 3561180 ESI IE 000 195,175 25 F082 2.22221 64 235,152 00 yras772 75,187.14 Doo 8Ss586 30.36% 2.2233] cr 94,824.00 6.89562 9.87975 000 18.7537 +7 69% 22236 55,508.00 000 13,767.00 000° 13,767.00 240% 2.6000] STORMEXCAVATE & 184,678.00 145,20687 18,075.38 000 163,282.35 Ba. 47% 2.8022] STORM TRUCK & ROCK 43.964 00 98.92951 18,414.66 009 s7.34417 13043% © -13°38017 2.8200] WATER EXGAVATE & LAND 367,37300 26927080 23,789.73 00d 293.0053 79.77% 74,303.47 2.8222] WATER TRUCK & ROCK 45,989.00, 1,675.63, 403.68 009 207831 4.52% 4390969 SANITARV.EXCAVATE 207.97600 169,944.50 0.00 174.17975 83.91% 33,396.25 SANITARY TRUCK & ROCK 47,016.00 807.01 2.00 2680701 57.02% 20,208.99 sive ul 14,212.00 144,666.24 000 47.15026 331.75% 22,938.26 SITE UTILITIES TRUCK & ROCK 4,355.00, 0.00 000497407 144.20% “619.07 JON CONTROL 12,500.00 0.00 0.00 000 0.00% 12,500.00 EQUIPMENT FUEL 65,904.00, 27,324.84 090 s0.s3702 76.68% 15,366.98, RETAINING WALL EXC & 8.52800 1.14209 000 4.75182 55.72% 3.76.48 ROCK OUTCROPPINGS 21,763.00 3,000.00 090 3.00000 13 78% 763.00 ENG & DESIGN ALLOWANCE 12,500.00 0.00 0.00 000 0.00% —12.s00.00 SITE LIGHTING BLOGET 248,492.00 0.00 0.00 000 0.00% 248,492.00 POWER SERVICE 91,577.00, 0.00 000 0.00 000% 91,577.00 GAS SERVICE 42,906.00, 000 0.00 000 0.00%, 42,906.00 PHONE & TV C 226,000.00 9.00 09 009 9.00% 226,000.00 LANDUSE ENTITLEMENT 2,000.00 0.00 00 009 0.00% 2,600.00 88-200] RETG WALL DESIGN ALLOWANCE $§.000.00 0.00 0.00 009 0.00% 5,090.00 86.300 | PERMITS & FEES 4330.00 1280.81 0.00 1.28081 2958% 3.04919 88.500] ENTRY MONUMENT 200,000.00 0.00 200 000 0.00% 200,000.60 86-600] SIGNAGE 10,000.00 0.00 0.00 000° 0.00% 10,000.00 60-800] SITE FURNISHINGS 0.00 000 0.00 0.00 0.00% 0.00 88-900] HYOROSEEDING 30,000.00, 000 0.00 000 0.00% 30,000.00 90-100} Fix ROAD 275.00 278.00 00 27800 10.00% 2.00 0-200] RE-TOPO SITE 4,420.00 4023.58 000 4,023.58 91.03% 306.42 87-000] CONTINGENCY 42,699.60 0.00 0.00 000 0.00% 42,699.60 86-000] PROFIT 27,994.00 128,236.30 36.139.22 000° 161.37552 58.05% © 116. 618.48CONTINUATION SHEET Application Date To y Architect's Project No. Invoice #: 969608 Contract: 0696- VILLAGES OF HAYDEN -_ « D © 1 * Scheduled uch Couate Reainage Value From Previous This Period Inlace (Note Dore) (oer) ‘96-000 INSURANCERIAB SITS Besa 105 000 "38.37800 00 00% Tor | Grand Totats 5,896,259.00 2,656,545.67 766,360.03 0.00 3,422,895.70 58.05% —2,473,963.30ANIWALVLS ADAMAOD ANY AML V SEAORV FHL AVE ALVIS SILL 4O SAV FHL WaGNA AWMMUGA AO ALIVNGd WAGNA ASLLYAD | ‘WHOd ISVATIN TWNOLLIGNOD V asi ‘divd N348 LON 3AVH 0A Al “GIVd N93@ LON ZAVH NOA al NAAT “LI NOISNOA 41 90A ASNIVOV 3'1VUOSNG SLINGINN204 SIL 'SLHORI ISOHL fl ONIAID NOd GIVd N43 FAVH NOA AHL SALVIS ONY ATIVNOLLIGNOONI SHOIY SAAIVA LN3IN0G SUL !2D1LON — y8no.4) qof pasuainyss sxoge ay or sute19 20ypue:* paysjusny stetsoqew “suamdinbo ‘saajasas 40 40} siusm.ud je s19409 a8vaqo4 st “aol paouaiojsa-axoge ayy uo sey poudtszapun 94) {orgs uy Jo siyBia pus suey re pue L MHD sated 10 osaag 190900) 09 tonsn.ysu0y wosusqoy, cmos MAAIVA IVD / NATTINTYALNT ‘oo NorianaIsNOD NOSNIZOYN219 To:276a107 APPLICATION AND CERTIFICATE FOR PAYMENT Hovoice #069609 ‘Toomer 4S DEVELOPMENTLTO LLP Freee 0696. VILLAGES OF HAYDEN ppcion Na 8 pane: seavvenoaoviny se uso 7321 utte — rs08 Sa. heen ROBKEON CONSTRUCTION cine eS 2'afo we asemaoo0 ove rat CONTRACTOR'S APPLICATION FOR PAYMENT ‘Aeclcaton wer ayer a hon commen ve Cert Corsten Sear eiacn 1. Orginal Contact Sum 2. Nee Change By Change Order 3. Conmset Sum Fe Date 4. Toul Completed and Stared To Die CONTRACTOR ROBINSON CONSTRUCTION co. © 00 of Stored Mea “$0.00 Sen Pra A Cho, se OCHFbO) BOD “Tal Retinege 320507729 siatteliaei toa Semescee? gmumecrs cemmcars Fon pave sone Soe eee Pam rps Pesce ae eee 7. Less Previous Cenfcaes For Payments. 8. Cument Payment Due 9. Baines Te Fini Phas Reni foe 300,702: oa mee a SS sur conneies § 644,716.63 (Pee eplnan fount cued ete te erat sph inc ie Alcon sa ene ‘Gonasa Sou! a pe ong io cont nite anc eneee (Giaxceonoin NAAR ‘Ase | —Dedacios Sac. so $0.00 Tehri 3009 32.00 Teas 3006 3090 Na Giga Can ter an Sent TO Caaor Wore @ OBR. os Hf rfote a Fouowrs up wa} Revacs on nf2loG as Do pipes Ration. RESPonE FROM Aapern THEY ADDED “Daan Peto © tue Ley loCONTINUATION SHEET Page a of 4 Replication sed Certification for Payment cooulning “Application Na, é Contractors signed cenfieation ie atached jon Date: 10/25/2006 tabulations below, amounts oe staid w the nearest dolla. aes tal af Use Cohumm ton Gantacts where vanable renege fr line ems my apply To: 141572006 Architect's Project No.: Invoice #: 969600 Contract: 0695- VILLAGES OF HAYDEN i st Bb . ¥ _} ito Datos oa Naw | ™ Frewnty | Sond | 5 onion | q PEEUTIAY RCE ‘aan e IFUENT MOBILIZATION 0.09 3 00) r 0.00) 2.2722] CRUSHED ROCK TRUCK 00 2.2755) CRUSHED ROCK PLACE 0.00 c 000 | 2.9000] sroRiexcavare ere. 00) | 28022) STORM:TRUCK & ROCK | 43,864.00) o00! 2.8200] WATER EXCAVATE & LAND 367,373.00) 0.00. 2222] WATER TAUCK a ROCK | 48.989009 00 SANITARY EXCAVATE 207;576.00 00 245472| SANITARY TRUCK 8 ROCK “4701600, 200 | 2200 8.00 zee) STE UTUTESTRLICKAROCK | “S35s00 a3, 2.7019] EROSION CONTROL 1 4280000 0.00: | 3.90400 2.00} 2.9000] RETARUNG WALL EXC & | “ei528.00 3.00} | 2.0001] Rock ourcrormiNcs | 2ueso 00 | ep-100) ENG & DESIGN ALLOWANCE 50000 aca] 88-110] SITE LIGHTING BUDGET 24849200 000 88-120] POWER SERVICE 9487700: 0.00; 8-120] GAs service | seeson00. 200] 85.140] PHONE & TV CONDUTT - z2sc00.00 00} 88-150] LANDUSE ENTITLEMENT | 2,000.00 000) 8-200|RETG WALL OESIGN ALLOWANCE | -eODII00" 800 99.300) PERMTS a reEs | “assoe0) 00] 86.500] ENTRY AONuNeE NT 1 zoe0co! 2.00] e200] sicnace “a000 C0 000 26-600 SITE FureisrGs | eco: 000 86.900] HYDROSEEONG | sets 200 20100) Ax ROAD L200) 200P.310 To:27e21e7 8 | 2602] saurrary-eooco CONTINUATION SHEET Application xed Cortficais for Payment comaloleg Gannett’ signed cerietion ince ‘Application 0: {n tabulations below, amount reed to the neaes olla ‘se Column Hon Coniracs where cnralecetsinaae for line ms may appl invoice #: 069609 Contract: 0698. VILLAGES OF HAYDEN [_—— oe Page? of & ‘Architect's Project No.: SURVEY FILING T SURVEY CALC FILING 2 (0-008 SURVEY TRAVEL 0-004] PRIOR COST BOUNDARIES 0-008] EXCAVATION SURVEY. (-006| UTILITY MOBSUBSISTENCE | Goo7|ReDisTRIBUTE TOPSON. (0-008 REMOVE MATL FROM W 0.009} AMERICAN WEST STANDBY 0-010] WETLAND CONSULTING. 8.011] JOHNSON RANCH POWER .o12| SITE FURNISHINGS. 0-013] OVER EXCAVATION 487.516.00! 85,77868) 103,133.38 2oa08t.72 2-585 ]GAS LINE 2-600] PAVING - ELAN 2-820] CURB-MARTINEZ 2.760] SITE FURNISHING 2-800] LANOSCAPE-WENOEN. 185,400.00) 1z9.638.96| 27681540) ess0.00! 38,338.00,Pisa To:2762107 CONTINUATION SHEET Page 4 ofa Application and Covtlication for Payment Sontaning ‘Conwartrs signed cenifictnon is eeacos atsboieons below, amounts are sted tthe nearest dolar Use Calum len Contacts were wartableretsinage for le es ey apply. Invoice ®: ogg609 Contract; 0898. VILLAGES OF HAYDEN j—«—| ae er ies Deserption of Work i Ne ac 1 [Babe] RETOPO STE | ! 98-000] PROF 98.000] INSURANCENIAB. | | 7 — savsassoa' sazzeanrel e7esasoe Iv 000 Grand Totate 4101,56878 69.56%To Krush From Walter ROBINSON ROBINSON Tesereate? Pate PI aHa4 QM AR? INTERIM LIEN / CLAIM WAIVER Fromm: Robinson Construction Co, Contact Persons yle Paimer Comtaet Telephone: S03.645-8537 CONDITIONAL RELEASE, ‘The undersigned docs hereby seknawledge that japon receipt by the undersigned ofa check from Co, (name of firm writing check) inthe sum of $9644,715.63 and when the encck has been penperty ‘endorsed and has been pald by the bank wpoa ‘Which it wax drawn this document shall become festive fo release pro temfo auy and all claims Yights of lien whieh the undersigned has on the above-referenced job. ‘This releate covers a eogress payinent for labor, services, equipment, and materials farnished and/or claims through ‘Actober 31,2006 only and docs not gover any ‘retention or itens furnished after that date. ‘Before any recipient of this document vetes ow it, said party should verify evidence of payment to the ungersigned. I CERIPY UNDER PENALTY OF PERJURY UNDER THE LAWS OP THIS STATE THAT ‘TUE ABOVE IS A "TRUE AND CORRECT STATEMENT, x, E in Stat at: OP County ot Spur and fvarm belo eA ey of see Nouty Paic Commission Bxpists: seer GB sete Oe Lime meee aang Projest: Villages of Hayden Project Manager: “Ryan Baraekman Projuct Phone: UNCONDITIONAL RELEASE ‘The undersigned docs hereby acknomtedge that the undersigned has been paid and hs received ogress puymente inthe sum of $___ for labor, services, equipment, or materials farmed to the ‘bore referenced job und Woes hereby release pro ‘tanto nay and al clans and rights of en whieh the undersigned has an the sbovecreferenced job, ‘This release covers all payments for labor serves, equipment, materials fernished andor tains to the above referonced jab treugh NOTICE: THIS DOCUMENT WAIVES RIGHS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCAULE AGAINST YOU IF YOU SIGN AT, EVEN IF YOU HAVE NOT BEEN PAID. UF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL RELEASE ross, 1 CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF TRIS STATE THAT ‘THE ABOVE IS A TRUE AND CORRECT STATEMENT. Sianterer ‘Nathried Cacparne Oates Tovweay eo Dates any i, (C1) re