Attachment_B,_SFS_Transmittal_Example.pdf
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- HOC Financial Support Services Federal contract opportunity
- Solicitation number
- 86548B18R00001
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Attachment B, SFS Transmittal Example
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Text version
SAMS-1106 Invoice Transmittal
Field Service Manager Billing Transmittal
Transmittal: SFS8A1700013 Atlanta 8A Transmittal Status: EF Status Date: 10/04/2017
FSM NAID: COMPANYNAID Remit: 24 ANYWHERE ST, Name: COMPANY NAME ANYWHERE USA, 22611
Contract: DABCED-17-X- Effective: 06/01/2017 Expiration: 05/31/2018
0XX
Type: Prompt Start Date: 09/22/2017 Due Date: 10/04/2017
Bill Period: 08/01/2017 EFT/Check: EFT
Total CLIN1: o.00 Total CLIN2: 33,663.00 Total CLIN3: o.00 Total CLIN4 136,150.00
Total CLIN5: 69,653.43 Total CUM/ 43,092.00 Total CLIN6: 38,965.20 Total CLIN7: o.00
Total CLIN8: 0.00 Total: 321,523.63 Net Total: 321,523.63
Preparer/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 B HOC Financial Support Services Example SFS Transmittal
Transmittal: SFS8A1700013 Atlanta 8A Transmittal Status: EF Status Date: 10/04/2017
FSM NAID: COMPANY NAID Remit: 24 ANYWHERE ST, Name: COMPANY NAME ANYWHERE USA
Type: Prompt Start Date: 09/22/2017 Due Date: 10/04/2017
Bill Period: 08/01/2017 EFT/Check: EFT
Total CLIN1: o.00 Total CLIN2: 33,663.00 Total CLIN3: o.00 Total CLIN4 136,150.00
Total CLIN5: 69,653.43 Total CUM/ 43,092.00 Total CLIN6: 38,965.20 Total CLIN7: o.00
Total CLIN8: 0.00 Total: 321,523.63 Net Total: 321,523.63
Detail
Case
No.
Amount Modified
Amount
Fee
Type
Notes Assigned/
Inspection
Date
Trigger
Criteria
Trigger
Value
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/02/2017 HPIR INSPECTION HV 08/03/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/02/2017 HPIR INSPECTION HV 08/03/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/02/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/02/2017 HPIR INSPECTION HV 08/03/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/02/2017 HPIR INSPECTION HV 08/03/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/03/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/03/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/03/2017 HPIR INSPECTION HV 08/03/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/03/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/03/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/03/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/03/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/04/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/04/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/04/2017 HPIR INSPECTION HV 08/05/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/04/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/04/2017 HPIR INSPECTION HV 08/04/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/04/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/04/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/04/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
Transmittal: SFS8A1700013 Atlanta 8A Transmittal Status: EF Status Date: 10/04/2017
Type: Prompt Start Date: 09/22/2017 Due Date: 10/04/2017
Bill Period: 08/01/2017 EFT/Check: EFT
Total CLIN1: o.00 Total CLIN2: 33,663.00 Total CLIN3: o.00 Total CLIN4 136,150.00
No.
Amount Modified
Amount
Fee
Type
Notes Assigned/
Inspection
Date
Trigger
Criteria
Trigger
Value
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/05/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/05/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/05/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/05/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/06/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/06/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/06/2017 HPIR INSPECTION HV 08/07/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/07/2017 HPIR INSPECTION HV 08/08/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/08/2017 HPIR INSPECTION HV 08/08/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/08/2017 HPIR INSPECTION HV 08/08/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/09/2017 HPIR INSPECTION HV 08/10/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/09/2017 HPIR INSPECTION HV 08/10/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/09/2017 HPIR INSPECTION HV 08/10/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/09/2017 HPIR INSPECTION HV 08/10/2017
147.00 0.00 PIH CLIN 2 08/09/2017 HPIR INSPECTION HV 08/10/2017
Transmittal: SFS8A1700013 Atlanta 8A Transmittal Status: EF Status Date: 10/04/2017
Type: Prompt Start Date: 09/22/2017 Due Date: 10/04/2017
Bill Period: 08/01/2017 EFT/Check: EFT
Total CLIN1: o.00 Total CLIN2: 33,663.00 Total CLIN3: o.00 Total CLIN4 136,150.00
No.
Amount Modified
Amount
Fee
Type
Notes Assigned/
Inspection
Date
Trigger
Criteria
Trigger
Value
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/09/2017 HPIR INSPECTION HV 08/10/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/09/2017 HPIR INSPECTION HV 08/11/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/10/2017 HPIR INSPECTION HV 08/10/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/10/2017 HPIR INSPECTION HV 08/11/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/10/2017 HPIR INSPECTION HV 08/10/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/10/2017 HPIR INSPECTION HV 08/11/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/10/2017 HPIR INSPECTION HV 08/11/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/10/2017 HPIR INSPECTION HV 08/11/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/10/2017 HPIR INSPECTION HV 08/11/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/11/2017 HPIR INSPECTION HV 08/12/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/11/2017 HPIR INSPECTION HV 08/12/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/11/2017 HPIR INSPECTION HV 08/12/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/11/2017 HPIR INSPECTION HV 08/14/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/11/2017 HPIR INSPECTION HV 08/12/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/11/2017 HPIR INSPECTION HV 08/12/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/11/2017 HPIR INSPECTION HV 08/14/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/11/2017 HPIR INSPECTION HV 08/14/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/12/2017 HPIR INSPECTION HV 08/12/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/12/2017 HPIR INSPECTION HV 08/12/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/12/2017 HPIR INSPECTION HV 08/12/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/12/2017 HPIR INSPECTION HV 08/14/2017
147.00 0.00 PIH CLIN 2 08/12/2017 HPIR INSPECTION HV 08/14/2017
Transmittal: SFS8A1700013 Atlanta 8A Transmittal Status: EF Status Date: 10/04/2017
Type: Prompt Start Date: 09/22/2017 Due Date: 10/04/2017
Bill Period: 08/01/2017 EFT/Check: EFT
Total CLIN1: o.00 Total CLIN2: 33,663.00 Total CLIN3: o.00 Total CLIN4 136,150.00
No.
Amount Modified
Amount
Fee
Type
Notes Assigned/
Inspection
Date
Trigger
Criteria
Trigger
Value
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/13/2017 HPIR INSPECTION HV 08/16/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/14/2017 HPIR INSPECTION HV 08/14/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/14/2017 HPIR INSPECTION HV 08/15/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/14/2017 HPIR INSPECTION HV 08/15/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/15/2017 HPIR INSPECTION HV 08/15/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/15/2017 HPIR INSPECTION HV 08/15/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/15/2017 HPIR INSPECTION HV 08/17/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/15/2017 HPIR INSPECTION HV 08/16/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/15/2017 HPIR INSPECTION HV 08/15/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/15/2017 HPIR INSPECTION HV 08/15/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/15/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/16/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/16/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/16/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/16/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/16/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/16/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/16/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/17/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/17/2017 HPIR INSPECTION HV 08/18/2017
091-XXXXXX
147.00 0.00 PIH CLIN 2 08/17/2017 HPIR INSPECTION HV 08/18/2017
147.00 0.00 PIH CLIN 2 08/17/2017 HPIR INSPECTION HV 08/18/2017
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