Atch_1_-_Performance_Certification.docx
DOCX document 42 KB Posted
- Solicitation number
- 1267T019R0001
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Atch 1 - Payment Certification
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PERFORMANCE-BASED PAYMENT CERTIFICATION
| Page |
| of |
| Unit (Region, Forest, District) |
| Project: |
| Contract No. |
| Name and Address of Contractor: |
| Invoice No. |
| Invoice Date: |
I hereby certify, to the best of my knowledge and belief, that –
1. The amounts requested are only for performance in accordance with the specifications, terms, and conditions of the contract;
2. Payment to subcontractors and suppliers have been made from previous payments received under the contract, 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; and
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.
(Name)
(Title)
(Date)
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