ARS_372.pdf

PDF 29 KB Posted

Attached to
Pavement Repairs at MS State Federal contract opportunity
Solicitation number
1232sd18Q0014
Issued by
Department of Agriculture Agricultural Research Service Central Program Planning Coordination and Support

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MS_State_Pavement_Repairs_Final_Specifications.pdf PDF
MS_State_Pavement_Repairs_Drawings_Final.pdf PDF
Bid_Bond.pdf PDF
ARS_371.pdf PDF

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c:\\docume~1\\admini~1.for\\mydocu~1\\accounts\\usda2\\origin~1\\set3~1\\ars372.wpf Administrator D:20050417122932- 04'00' D:20050426102902- 04'00'

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 MATERIAL STORED AT THE SITE (See Item 5 above) Description Value

CONTRACTOR'S PROGRESS PAYMENT CERTIFICATION

SIGNATURE OF CONTRACTOR'S AUTHORIZED REPRESENTATIVE

RECOMMENDED FOR PAYMENT (Signature of EPM, COR, CM or A-E as appropriate) CONCUR (Signature of EPM or COR as appropriate)

DATE SIGNED

DATE SIGNED

DATE SIGNED

Form ARS-372 (06/2011)

USDA-ARS

This form was electronically produced by USDA/ARS/OCIO/ADB.

% retainage The amounts requested are only for performance in accordance with the specifications, terms, and conditions of the contract;

(1) (2) All payments due to subcontractors and suppliers from previous payments received under the contract have been made, and timely payments will be made from the proceeds of the payment covered by this certification, in accordance with subcontract agreements and the requirements of Chapter 39 of Title 31, United States Code;

(3) This request for progress payments does not include any amounts which the prime contractor intends to withhold or retain from a subcontractor or supplier in accordance with the terms and conditions of the subcontract; and This certification is not to be construed as final acceptance of a subcontractor's performance.

(4) I hereby certify, to the best of my knowledge and belief, that - Previous edition is not usable.

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Check if Final payment.: 0
Enter date for period beginning using format MM/DD/YYYY.:
Enter date for period ending using format MM/DD/YYYY.:
Item. 1. Amount of original contract.:
Item 2. Change orders and / or amendments.:
Item 3. Total adjusted contract prices.:
Item 4. Value of work completed to end of period.:
Item 5. Value of material stored at the site (Itemize below).:
Item 6. Total value of work completed and stored material (Line 4 plus Line 5). Value of material stored at the site (Itemize below).:
Item 7. Enter Percent retainage.:
Item 7. Less indicated percentage retainage.:
Item 8. Total due contractor thru end of this period.:
Item 9. Less previous requests.:
Item 10. Net amount due contractor this payment.:
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