140R3025B0002_Attachment_5a_-_Invoice_(Construction).docx
DOCX document 31 KB Posted
- Attached to
- K12 Drop-Arm Road Barriers at Davis Dam
- Solicitation number
- 140R3025B0002
About this file
This document is an invoice template for construction contracts with the Bureau of Reclamation, specifically designed for progress payment submissions. The template is associated with Solicitation Number 140R3025B0002 for K12 Drop-Arm Road Barriers at Davis Dam, a project under the Department of the Interior Bureau of Reclamation. The invoice form requires detailed contractor information, including contract number, invoice period, contractor name and address, and a breakdown of payment amounts for prime contractors, subcontractors, and other entities. The form includes a payment certification section where the contractor must verify that payments are in accordance with contract specifications, subcontractor agreements, and federal payment regulations, and must be signed and dated by an authorized representative.
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Text version
Solicitation or Award Number: Page 1 of 2
In accordance with Reclamation Acquisition Regulation WBR 1432.903(b)(2), this form is required for construction awards that will be invoiced through Reclamation’s Invoicing SharePoint Site (non-IPP).
INVOICE (Construction)
| Request Payment No. _____ ☐ Progress (__% Complete) ☐ 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: _____________________________________________________
Name/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
WBR 1432.903-1a Construction Payment eFile - F01 (03/2019)
File details come from the government source that posted it. Updated .