Attachment_12_Invoice_(Construction).pdf

Document No.

140R3019R0001

Document Title Turbine and Generator Hydroelectric Component Manufacturing and Rehabilitation IDIQ

Attachment 12 - Invoice (Construction)

(Rev. 06/2012) INVOICE (Construction)

Request Payment No. _______ [ ] Progress [ ] Final [ ] Small Business/QuickPay Invoice Date: _____________ [ ] Prime Contractor/QuickPay with subcontractors

INVOICE PERIOD (MO/YR): CONTRACT NO. __________

CONTRACT TITLE: _____________________________________________

CONTRACTOR NAME: ______________________________

CONTRACTOR ADDRESS: ___________________________________

NAME/TITLE/ADDRESS/PHONE # OF PERSON TO NOTIFY IN EVENT OF DEFECTIVE

INVOICE: _________________________________________________________________

INVOICE AMOUNT:

1. PRIME CONTRACTOR:

2. SUBCONTRACTOR:

3. OTHER:

4. INVOICE TOTAL:

PAYMENT METHOD: Electronic Fund Transfer (EFT)

CONTRACTOR’S PAYMENT CERTIFICATION:

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) Payments 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 their 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; and (4) This certification is not to be construed as final acceptance of a subcontractor’s performance.

AUTHORIZED SIGNATURE: _______________________________________________________

Title: __________________________________________________ Date: ___________________

SPACE BELOW THIS LINE TO BE COMPLETED BY BUREAU OF RECLAMATION

AND SIGNED BY THE CONTRACTING OFFICER’S REPRESENTATIVE (COR)

Date Invoice Received:

( ) Invoice certified correct for payment in the amount of $ as shown on

CONTRACT SUMMARY AND VOUCHER, ESTIMATE NO. Month of

( ) Invoice certified correct for payment in the amount of $

Certified Correct by:

(Signature) (Title) (Date)

MONTHLY CERTIFICATE OF LABOR CONFORMANCE

I, , (Name), certify , (Contractor), and all subcontractors have conformed with the Labor Standard Provisions of

Contract No. _________ , for the period ending ; except that there is an honest dispute with respect to the following required provisions:

(State "none" or include a detailed report of the dispute or disputes in question).

Signed

Title

Date

SUBCONTRACTOR / SUPPLIER PAYMENT SUMMARY

INVOICE PERIOD (MO/YR): _________________________________CONTRACT No.

SUBCONTRACTORS:

SF-1413

on file -- to be checked by Agency

Subcontractor Name

Subcontractor Contract Amount With Prime Contractor

Amount Previously Paid

Amount Paid From This Invoice

Adjustment

TOTAL PAID

SUPPLIERS:

Supplier Name

Supplier Estimated Contract Amount With Prime Contractor

Amount Previously Paid

Amount Paid From This Invoice

Adjustment

TOTAL PAID