01_18382348_Specs_Attachment 1 Request for Payment Form.xlsx

XLSX spreadsheet 27 KB Posted Apr 7, 2023

Attached to: USCG Base Kodiak Paving IDIQ
Solicitation number: 70Z08723RKODI8270978
Issued by: Department of Homeland Security US Coast Guard

View the file

Other files

File	Type	Posted
Revised__Kodiak_Paving_IDIQ_Price_Schedule.xlsx	XLSX spreadsheet	Apr 17, 2023
Amend 0001_23KODI8270978_Paving IDIQ.pdf	PDF	Apr 17, 2023
01_18382348_Specs_Attachment 10 Delegation Signatory.pdf	PDF	Apr 7, 2023
01_18382348_Specs_Attachment 6 Request for variations_sample.pdf	PDF	Apr 7, 2023
01_18382348_Specs_Attachment 7 Request for Deviation Form_Sample.pdf	PDF	Apr 7, 2023
01_18382348_Specs_Attachment 2 DHS Contractor Release.pdf	PDF	Apr 7, 2023
01_18382348_Specs_Attachment 11 Base Kodiak Generic EMP_12032021.pdf	PDF	Apr 7, 2023
01_18382348_Specs_Attachment 5 Submittal Register.pdf	PDF	Apr 7, 2023
01_18382348_Specs_Attachment 8 Daily Report.pdf	PDF	Apr 7, 2023
01_18382348_Specs_Attachment 3 Daily Report_sample.xlsx	XLSX spreadsheet	Apr 7, 2023
01_18382348_Specs_Attachment 4 Submittal Transmittal Form.pdf	PDF	Apr 7, 2023
01_18382348_Specs_Attachment 9 Test Report Form_Sample.pdf	PDF	Apr 7, 2023
4_Past Performance Questionnaire.pdf	PDF	Apr 5, 2023
5_CertCrnt CostPrice Data_PavingIDIQ.pdf	PDF	Apr 5, 2023
3_WD_AK20230007_Dated_1-6-2023.pdf	PDF	Apr 5, 2023
7_TO RFP FY23 Polaris_StElias.pdf	PDF	Apr 5, 2023
18382348_SPECS.pdf	PDF	Apr 5, 2023
CGPD Vetting Request.pdf	PDF	Apr 5, 2023
RFP_Kodiak_Paving_IDIQ_4-5-23.pdf	PDF	Apr 5, 2023
18382348_Drawings.pdf	PDF	Apr 5, 2023
Ombudsman Program Notice.pdf	PDF	Apr 5, 2023
1_SOW Section 01 11 00_PN 8270978.pdf	PDF	Apr 5, 2023
6_SF24-Bid Bond.pdf	PDF	Apr 5, 2023
WD_AK20230007_Dated_1-6-2023.pdf	PDF	Apr 5, 2023
Facility Access Instructions (Base Kodiak).pdf	PDF	Apr 5, 2023
2_Kodiak_Paving_IDIQ_Price Schedule.xlsx	XLSX spreadsheet	Apr 5, 2023

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PAY REQUEST

REQUEST FOR PROGRESS PAYMENT (CONSTRUCTION)
From:		Contract Number:
Contractors Name		Payment Request No.
Address		Date:
City, State, Zip		Period From:
		To:
Tax ID Number:
Contact Point/Telephone Number:
PROMPT PAYMENT DISCOUNT		0	%
To:	Contracting Officer, USCG CEU Juneau, PO BOX 25517, Juneau, AK 99802-2517
Via:	PM/COR, CEU Juneau
Request is made for Payment as shown below, in connection the Contract. The present status of account
for this contract is as follows:
Original Contract Amount:
Net Change through Mod No. _____ :		$ - 0
Total Contract Amount to Date:		$ - 0
Total Completed & Earned to Date:		$ - 0
Less Subcontractor Retainage - Cum		$ - 0
Less Previous Payments		$ - 0
SUBTOTAL		$ - 0
Less Cumulative Retainage:		$ - 0
Total Completed & Earned this Period:		$ - 0
Retainage Withheld this Period		$ - 0
Current Payment Due		$ - 0

Contractor's Signature			Date
To be completed by Project Manager:
Approved for:	Partial	Payment of
	Final

Construction Inspector Date

Project Manager/Contracting Officer's Representative Date

DHS-USCG

CEU Juneau

CERTIFICATION

Contractor's Signature					Date
Sub Contractor	Total Sub-	Cummulative	Cumm Amt	Prev Pymts	Actual Payment
Name	Contract Amount	Completed	of Retainage	to Sub	Due This Invoice
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

TOTAL	TOTAL	TOTAL	TOTAL	TOTAL
$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

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 subcontract agreements and the requirements of Chapter 39 of Title 31, United States Code; and (3) This request for progress payment 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.

File details come from the government source that posted it. Updated Apr 7, 2023.