Attachment 4_ARS-372.pdf

PDF 30 KB Posted

Attached to
LED Lighting Retrofit, Stuttgart, AR Federal contract opportunity
Solicitation number
12405B24Q0298
Issued by
Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery

About this file

This document is a Contractor's Request for Payment Transmittal form (ARS-372) used by the U.S. Department of Agriculture Agricultural Research Service (USDA-ARS) to request and approve partial payments to contractors. The form details the original contract amount, change orders, total adjusted contract price, value of work completed, value of materials stored on-site, total due to the contractor, and the net amount due for the current payment period. It includes a certification by the contractor and signatures from the Contracting Officer's Representative (COR) and/or Engineering Project Manager (EPM) recommending and approving the payment.

This form is related to a federal contract opportunity for an LED Lighting Retrofit project at the USDA-ARS facilities in Stuttgart, Arkansas. The project has a NAICS code of 238210 and a small business size standard of $19 million. A site visit is scheduled for August 5, 2024, and the solicitation number is 12405B24Q0298. The contracting agency is the USDA-ARS Southeast Area.

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Other files for this federal contract opportunity

Other files attached to LED Lighting Retrofit, Stuttgart, AR, newest first.
File Type Posted
Attachment 1_LED Lighting Retrofit SOW_Amd_0002_Redacted.pdf PDF
Attachment 1_LED Lighting Retrofit SOW_Amd_0002.pdf PDF
Sol_12405B24Q0298_Amd_0002.pdf PDF
QAs.pdf PDF
Sol_12405B24Q0298_Amd_0001.pdf PDF
Sol_12405B24Q0298.pdf PDF
Attachment 3_ARS-371.pdf PDF
Attachment 2_Davis Bacon Act WD AR20240018.pdf PDF
Attachment 5_ARS Facilities Design Standards ARS-242.1.pdf PDF
Attachment 6_SF 24 Bid Bond.pdf PDF
Attachment 7_Experience Sheet.docx DOCX document
Attachment 1_LED Lighting Retrofit SOW_Redacted.pdf PDF
Attachment 8_Past Performance Questionnaire.docx DOCX document
Show all 13

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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

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/EASB.

% 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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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/EASB.

% 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.

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.:
Value. Line 1.:
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Partial payment number.:
Project.:
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Location.:
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