Attachment_A,_SAM_Transmittal_Example.pdf
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- Attached to
- HOC Financial Support Services Federal contract opportunity
- Solicitation number
- 86548B18R00001
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Attachment A, SAM Transmittal Example
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Text version
SAMS-1106 Invoice Transmittal
Asset Manager Billing Transmittal
Transmittal: SAM8A1800001 Contract Area: 8A Total CLIN 1 (MKT): 18,237.01
Transmittal Status: EF Type: Prompt Total CLIN 2 (MKT): 72,938.41
Status Date: 10/26/2017 Prompt Start Date: 10/05/2017 Total CLIN 3 (ACA): o.00
AM NAID: NAID NUMBER Due Date: 10/26/2017 Total CLIN GTR: o.00
Name: COMPANY NAME Bill Period: 09/01/2017 Total: 91,175.42
Check/EFT Flag: EFT Net Total: 91,175.42
Remit: 24 ANYWHERE ST, ANYWHERE USA
Prepare/Reviewer/Approver Certification -
Disbursements are being made under U.S. Department of Treasury delegation of authority based upon this certification.❑To the best of my knowledge, all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Preparer's Signature Date (mm/dd/yyyy) Title and Phone
Reviewer's Signature Date (mm/dd/yyyy) Title and Phone
Approver's Signature
Date (mm/dd/yyyy) Title and Phone
Section IV: For HUD Certifying Officer Use Only - Pursuant to authority vested in me. I certify that this transmittal and its attachments are correct and proper for payment.
Certifying Officer's Signature
Date (mm/dd/yyyy) Title and Phone
H56750 Text Box PWS Attachment A HOC Financial Support Services Example SAM Transmittal
Transmittal: SAM8A1800001 Contract Area: 8A Total CLIN 1 (MKT): 18,237.01
Transmittal Status: EF Type: Prompt Total CLIN 2 (MKT): 72,938.41
Status Date: 10/26/2017 Prompt Start Date: 10/05/2017 Total CLIN 3 (ACA): o.00
Remit: 24 ANYWHERE ST, ANYWHERE USA
ADetail di
Case Amou Modifi Fee Note Assign Contract Contra Contr DP Net Bid CLIN Trigger Trigger Days
No. nt ed Type s ed Number ct act Progr Amount/ % Criteria Value not
Amou nt
Date Period Sale
Type am
Type
Apprais al
Rea d y to Show
091- 227.0 0.00 MKT CLIN 07/19/ ABCDE- 0003 UI
32,900. 0.69 STEP 10 09/14/
1 8A01 2017 B-15-D- 00 DATE,LIST 2017,
06 PRICE,SAL 22000,
E 35000, PRICE,SAL 09/1
E DATE,#
OF
091- 426.5 0.00 MKT CLIN 07/28/ ABCDE- 0003 UI
61,823. 0.69 STEP 10 09/07/
8 8A01 2017 B-15-D- 80 DATE,LIST 2017,
06 PRICE,SAL 55000,
E 65770, PRICE,SAL 09/0
E DATE,#
91- 278.9 0.00 MKT CLIN 07/06/ ABCDE- 0003 UI
40,420. 0.69 STEP 10 09/05/
0 8A01 2017 B-15-D- 00 DATE,LIST 2017,
06 PRICE,SAL 40000,
E 43000, PRICE,SAL 09/0
E DATE,#
92- 913.5 0.00 MKT CLIN 07/03/ ABCDE- 0003 IE
132,405 0.69 STEP 10 09/25/
9 8A01 2017 B-15-D- .00 DATE,LIST 2017,
06 PRICE,SAL 57000,
E 14550
PRICE,SAL 0, 09/
E DATE,#
Transmittal: SAM8A1800001 Contract Area: 8A Total CLIN 1 (MKT): 18,237.01
Transmittal Status: EF Type: Prompt Total CLIN 2 (MKT): 72,938.41
Status Date: 10/26/2017 Prompt Start Date: 10/05/2017 Total CLIN 3 (ACA): o.00
Remit: 24 ANYWHERE ST
ANYWHERE USA
ADetail di
Case Amou Modifi Fee Note Assign Contract Contra Contr DP Net Bid CLIN Trigger Trigger Days
No. nt ed Type s ed Number ct act Progr Amount/ % Criteria Value not
Amou nt
Date Period Sale
Type am
Type
Apprais al
Rea d y to Show
093- 585.0 0.00 MKT CLIN 07/19/ ABCDE- 0003 UI
84,788. 0.69 STEP 10 09/25/
4 8A01 2017 B-15-D- 94 DATE,LIST 2017,
06 PRICE,SAL 85000,
E 90201, PRICE,SAL 09/2
E DATE,#
093- 269.8 0.00 MKT CLIN 08/21/ ABCDE- 0003 UI
39,104. 0.69 STEP 10 09/29/
2 8A01 2017 B-15-D- 00 DATE,LIST 2017,
06 PRICE,SAL 41500,
E 41600, PRICE,SAL 09/2
E DATE,#
093- 421.5 0.00 MKT CLIN 07/20/ ABCDE- 0003 UI
61,100. 0.69 STEP 10 09/14/
9 8A01 2017 B-15-D- 00 DATE,LIST 2017,
06 PRICE,SAL 65000,
E 65000, PRICE,SAL 09/1
E DATE,#
093- 428.0 0.00 MKT CLIN 07/08/ ABCDE- 0003 UI
62,040. 0.69 STEP 10 09/21/
8 8A01 2017 B-15-D- 00 DATE,LIST 2017,
06 PRICE,SAL 65000,
E 66000, PRICE,SAL 09/2
E DATE,#
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