Progress_Payment_Form_(J.6.).xlsx
XLSX spreadsheet 16 KB Posted
- Attached to
- Repair Roof at UPH ATC Mobile, Alabama
- Solicitation number
- 70Z082-18-B-PAT000-00
About this file
Attachment J.6. Payment Form
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
INVOICE
| OFFICE OF COMMANDING OFFICER, CIVIL ENGINEERING UNIT, MIAMI | ||||||
| REQUEST FOR PAYMENT INVOICE | ||||||
| PROJECT: Contract Number | CONTRACTOR NAME: | |||||
| TASK ORDER NO. ____________________ | (if applicable) | ADDRESS | ||||
| APPLICATION DATE: | APPLICATION No. | |||||
| TO: Contracting Officer, CEU MIAMI | ||||||
| NOTE: (Must obtain COTR Signature before sumbmission) | PERIOD FROM: | TO: |
| I hereby certify, to the best of my knowledge and | Application is made for Payment, as shown below in | ||
| belief that: | Connection with the Contract. The present status of | ||
| (1) The amounts requested are only for performance | the account for this contract is as follows: | ||
| in accordance with the specifications, terms and | |||
| conditions of the contract: | ORIGINAL CONTRACT SUM | $0.00 | |
| (2) Payments to subcontractors and suppliers have | |||
| been made from previous payments received under the | NET CHANGE BY MODIFICATION | $0.00 | |
| contract and timely payments will be made from the | |||
| proceeds of the payment covered by this certifica- | CONTRACT SUM TO DATE | $0.00 | |
| tion. In accordance with subcontract agreements | |||
| and the requirements of Chapter 39 of Title 31, | |||
| United States Code; and | TOTAL COMPLETED-STORED TO DATE | $0.00 | |
| (3) This request for progress payments does not | |||
| include any amounts which the prime contractor | RETAINAGE | 0% | $0.00 |
| intends to withhold or retain from a subcontractor | |||
| or supplier in accordance with the terms and | TOTAL EARNED LESS RETAINAGE | $0.00 | |
| conditions of the subcontract. | |||
| LESS PREVIOUS PAYMENTS | $0.00 | ||
| SIGN __________________________________________ | |||
| (Title) _______________________________________ | CURRENT PAYMENT DUE | $0.00 | |
| (Date) ________________________________________ | |||
| PERCENT OF TOTAL JOB COMPLETE | ERROR:#DIV/0! | ||
| CONTRACTING OFFICER: Representative’s certifica- | |||
| tion of Receipt of services at project site. | ACCOUNTING DATA | ||
| Changes to requested amount have been initiated. |
Sign and Date ________________________________
| Print phone number and mailing address of person | ||
| To be notified in event the Contracting Officer | ||
| finds this application to be defective. | BY: | DATE: |
(Address) ____________________________________
_______________________ (Phone) ______________ APPROVED FOR PAYMENT OF
CONTINUATION SHEET
| CONTINUATION SHEET | CONTRACT No. HSCGG82-_________________ | ||||||||
| FOR REQUEST FOR PROGRESS PAYMENT | APPLICTION NO. ______ | ||||||||
| WORK COMPLETED | (1)* | TOTAL COMPLETED | BALANCE | ||||||
| ITEM | DESCRIPTION OF WORK | SCHEDULED | PREVIOUS | THIS | STORED | AND STORED TO | TO FINISH | RETAINAGE | |
| NO. | VALUE | APPLICATIONS | APPLICATION | MATERIALS | DATE | ||||
| A. | B. | C. | D. | E. | F. | G(D+E+F) | % | H(C-G) | I. |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ERROR:#DIV/0! | $0.00 | |||
| TOTAL | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| (1)* STORED MATERIALS – Unincorporated material delivered to the job site. Request for payment for uninstalled | |
| material delivered to the job site must be accompanied by paid invoices. |
File details come from the government source that posted it.