5. Subcontractor Periodic Payment Confirmation.pdf
PDF 71 KB Posted
- Solicitation number
- 25-046
- Issued by
- El Paso County, Colorado
About this file
The document is a Subcontractor Periodic Payment Confirmation form from the El Paso County Department of Public Works, designed to track and verify payments to subcontractors on a construction project. The form is specifically related to the Widefield Community Park - Crews Gulch Regional Trail Phase II project, which involves constructing an eight-foot wide concrete trail, installing three ADA-compliant pedestrian concrete curb ramps, and implementing crosswalk stripes on Widefield Boulevard, along with associated mobilization, traffic control, and temporary stormwater control measures.
The form provides a detailed mechanism for prime contractors to report subcontractor invoices, payment amounts, payment dates, work completion status, and requires signed declarations from both the prime and subcontractor representatives. The document includes multiple rows to track multiple subcontractor payments, with checkboxes to indicate work completion, exception requests, and payment verification. There are specific instructions regarding timely payment to subcontractors, with potential consequences for delayed or inaccurate reporting, including potential withholding of future payments by the county and liability for interest payments.
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Text version
COUNTY USE ONLY
Periodic
Final
2 Invoice
Amount
4 Payment
Date
5 Exception
Requested
6 Work
Completed 7 Sub Initials
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
$ / / Y N Y N
Date
Date
* Submit a signed copy of this form to the Project Engineer. Frequency will be determined at the preconstruction meeting.
More frequent submittals may be requested by the County at any time.
2 List the amount of the subcontractor invoice and 3 payment to the subcontractor
1 Accurately describe the work performed / supplies provided by the subcontractor.
For the Periodic report, summarize the subcontractor participation during the reporting period.
For the Final report, summarize all subcontractor participation on the contract. Attach additional pages as necessary.
4 Provide the date that the subcontractor was paid.
3 Payment
Amount
~ Failure to timely complete this form will result in delay of your next payment from the County.
Failure to accurately complete this form could result in the delay of future payments from the County.
7 Subcontractor shall provide initials indicating receipt of payment.
6 Mark whether subcontractor has completed all work specified in the subcontractor purchase order
5 Mark whether you have requested approval of a good cause exception. A good cause exception is required if you did not pay your subcontractor within seven days of receipt of payment from the County.
1 Work Performed /
Supplies Provided
Project Name / #:
Date EPC Received:
Prime Contractor:
Subcontractor:
EL PASO COUNTY
DEPARTMENT OF PUBLIC WORKS
SUBCONTRACTOR PERIODIC
PAYMENT CONFIRMATION Through Pay Estimate / Invoice #Project Start Date:
Title
TitleSignature
Prime Contractor Representative Name
Subcontractor Representative Name
Signature
RELEASE RETAINAGE
(Final Report Only)
I declare under penalty of perjury in the second degree and any other applicable state or federal laws that the statements made in this document are complete, true and accuarate and that my company has complied with El Paso County specifications and all other relevant contract provisions.
I acknowledge that if payment has not been made consistent with the representations herein, my company may be liable for interest pursuant to the Contract and the County may withhold payments to my company until all required payment have been made to subcontractors.
(created 3/26/15)
File details come from the government source that posted it. Updated .