1. Att-7 ARS 372 Contractors Request for Payment Transmittal.pdf
PDF 62 KB Posted
- Attached to
- Wellington Barn Cold Room Retrofit
- Solicitation number
- 12305B23R0013
About this file
This document is a contractor's request for payment transmittal form for Contract No. at the PROJECT LOCATION. The form requests payment for work completed through the period ending date and includes fields for the original contract amount, approved change orders and amendments, adjusted total contract price, value of work completed through the payment period including stored materials with itemized descriptions and values, retained percentage, total due the contractor, and previous payment amounts. The contractor certifies payment to subcontractors and suppliers from prior proceeds and commitment to timely payment from proceeds of the request. Signatures are required from the contractor and concurring signatures from the EPM, COR, CM or AE as appropriate are also included.
The related federal contract opportunity is solicitation number 12305B23R0013 for retrofitting the cold room at the Wellington Barn location for the USDA Agricultural Research Service Northeast Area Field Research Implementation and Information Delivery office. The solicitation type is listed as an opportunity.
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Text version
CONTRACTOR'S REQUEST FOR PAYMENT TRANSMITTAL
CONTRACT NO.
PROJECT
LOCATION
PARTIAL PAYMENT NO.
REQUISITION NO.
FOR PERIOD BEGINNING ENDING
FINAL PAYMENT
ITEM AMOUNT
1. Amount of original contract
2. Change orders and/or amendments
3. Total adjusted contract prices
4. Value of work completed to end of period
5. Value of material stored at the site (Itemize below)
6. Total value of work completed and stored material (Line 4 plus Line 5).
8. Total due contractor thru end of this period
9. Less previous requests
10. Net amount due contractor this payment
7. Less % retainage
MATERIAL STORED AT THE SITE (See Item 5 above)
Description Value
CONTRACTOR'S CERTIFICATION OF PAYMENT
By signing this request for payment, I certify that I have made payment from the proceeds of prior payments, and that I will make timely payment from the proceeds of this payment, of amounts due my subcontractors and suppliers in accordance with my con-tractual arrangements with them.
SIGNATURE OF CONTRACTOR'S AUTHORIZED REPRESENTATIVE
RECOMMENDED FOR PAYMENT (Signature of EPM, COR, CM or A.E. as ppropriate)
CONCUR (Signature of EPM or COR as appropriate)
DATE SIGNED
DATE SIGNED
DATE SIGNED
Form ARS-372 (11/84) Replaces SEA-372 (1/79) which may be used. USDA-ARS This form was electronically produced by USDA/ARS/ITD using InForms software.
Attachment-7
File details come from the government source that posted it. Updated .