ARS-372.pdf
PDF 90 KB Posted
- Attached to
- Cable Replacement, Splicing, and Testing Federal contract opportunity
- Solicitation number
- 12505B25R0008
About this file
This document is Form ARS-372 (06/2011), a Contractor's Request for Payment Transmittal form used by the USDA Agricultural Research Service. The form serves as a standardized template for contractors to request payment and includes sections for documenting the original contract amount, change orders/amendments, work completed, stored materials, and retainage calculations.
The form requires certification from the contractor that payments are only for work performed according to specifications, that subcontractors have been paid, and that no unauthorized withholdings are included. It includes signature lines for the contractor's authorized representative, payment recommendation (from EPM, COR, CM or A-E), and concurrence (from EPM or COR). The form contains 10 numbered line items for financial calculations and a section to itemize materials stored on-site.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| SF 30 -12505B25R0008 - 0002 Amendment with Q-A.pdf | ||
| SF 30 Amendment 01.pdf | ||
| Image 1.pdf | ||
| Past Performance Questionnaire.pdf | ||
| Statement of Work.pdf | ||
| ELECTRIC Redline Drawing.pdf | ||
| ARS-371.pdf | ||
| WD IA20250074 01-03-2025.pdf | ||
| SF 1442.pdf | ||
| Image 3.pdf | ||
| Image 2.pdf |
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Text version
CONTRACTOR'S REQUEST FOR PAYMENT TRANSMITTAL
CONTRACT NO.
PROJECT
LOCATION
PARTIAL PAYMENT NO.
REQUISITION NO.
FOR PERIOD BEGINNING ENDING
FINAL PAYMENT
ITEM AMOUNT
1. Amount of original contract
2. Change orders and/or amendments
3. Total adjusted contract prices
4. Value of work completed to end of period
5. Value of material stored at the site (Itemize below)
6. Total value of work completed and stored material (Line 4 plus Line 5).
8. Total due contractor thru end of this period
9. Less previous requests
10. Net amount due contractor this payment
7. Less
MATERIAL STORED AT THE SITE (See Item 5 above) Description Value
CONTRACTOR'S PROGRESS PAYMENT CERTIFICATION
SIGNATURE OF CONTRACTOR'S AUTHORIZED REPRESENTATIVE
RECOMMENDED FOR PAYMENT (Signature of EPM, COR, CM or A-E as appropriate)
CONCUR (Signature of EPM or COR as appropriate)
DATE SIGNED
DATE SIGNED
DATE SIGNED
Form ARS-372 (06/2011) USDA-ARS This form was electronically produced by USDA/ARS/OCIO/EASB.
% retainage
The amounts requested are only for performance in accordance with the specifications, terms, and conditions of the contract;(1)
(2) All payments due to subcontractors and suppliers from previous payments received under the contract have been made, 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;
(3) This request for progress payments 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; and This certification is not to be construed as final acceptance of a subcontractor's performance.(4)
I hereby certify, to the best of my knowledge and belief, that -
Previous edition is not usable.
c:\\docume~1\\admini~1.for\\mydocu~1\\accounts\\usda2\\origin~1\\set3~1\\ars372.wpf Administrator D:20050417122932- 04'00' D:20050426102902- 04'00'
CONTRACTOR'S REQUEST FOR PAYMENT TRANSMITTAL
CONTRACT NO.
PROJECT
LOCATION
PARTIAL PAYMENT NO.
REQUISITION NO.
FOR PERIOD BEGINNING
ENDING
FINAL PAYMENT
ITEM
AMOUNT
1. Amount of original contract
2. Change orders and/or amendments
3. Total adjusted contract prices
4. Value of work completed to end of period
5. Value of material stored at the site (Itemize below)
6. Total value of work completed and stored material (Line 4 plus Line 5).
8. Total due contractor thru end of this period
9. Less previous requests
10. Net amount due contractor this payment
7. Less MATERIAL STORED AT THE SITE (See Item 5 above) Description Value
CONTRACTOR'S PROGRESS PAYMENT CERTIFICATION
SIGNATURE OF CONTRACTOR'S AUTHORIZED REPRESENTATIVE
RECOMMENDED FOR PAYMENT (Signature of EPM, COR, CM or A-E as appropriate) CONCUR (Signature of EPM or COR as appropriate)
DATE SIGNED
DATE SIGNED
DATE SIGNED
Form ARS-372 (06/2011)
USDA-ARS
This form was electronically produced by USDA/ARS/OCIO/EASB.
% retainage The amounts requested are only for performance in accordance with the specifications, terms, and conditions of the contract;
(1) (2) All payments due to subcontractors and suppliers from previous payments received under the contract have been made, 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;
(3) This request for progress payments 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; and This certification is not to be construed as final acceptance of a subcontractor's performance.
(4) I hereby certify, to the best of my knowledge and belief, that - Previous edition is not usable.
| Check if Final payment.: 0 |
| Enter date for period beginning using format MM/DD/YYYY.: |
| Enter date for period ending using format MM/DD/YYYY.: |
| Item. 1. Amount of original contract.: |
| Item 2. Change orders and / or amendments.: |
| Item 3. Total adjusted contract prices.: |
| Item 4. Value of work completed to end of period.: |
| Item 5. Value of material stored at the site (Itemize below).: |
| Item 6. Total value of work completed and stored material (Line 4 plus Line 5). Value of material stored at the site (Itemize below).: |
| Item 7. Enter Percent retainage.: |
| Item 7. Less indicated percentage retainage.: |
| Item 8. Total due contractor thru end of this period.: |
| Item 9. Less previous requests.: |
| Item 10. Net amount due contractor this payment.: |
| Value. Line 1.: |
| Value. Line 2.: |
| Value. Line 3.: |
| Value. Line 4.: |
| Value. Line 5.: |
| Value. Line 6.: |
| Value. Line 7.: |
| Value. Line 8.: |
| Value. Line 9.: |
| Contractor's request for payment transmittal. Enter contract number.: |
| Partial payment number.: |
| Project.: |
| Requisition number.: |
| Location.: |
| Description. Line 1.: |
| Description. Line 2.: |
| Description. Line 3.: |
| Description. Line 4.: |
| Description. Line 5.: |
| Description. Line 6.: |
| Description. Line 7.: |
| Description. Line 8.: |
| Description. Line 9.: |
| Value. Line 10.: |
| Value. Line 11.: |
| Value. Line 12.: |
| Value. Line 13.: |
| Value. Line 14.: |
| Value. Line 15.: |
| Value. Line 16.: |
| Value. Line 17.: |
| Description. Line 10.: |
| Description. Line 11.: |
| Description. Line 12.: |
| Description. Line 13.: |
| Description. Line 14.: |
| Description. Line 15.: |
| Description. Line 16.: |
| Description. Line 17.: |
| Enter date in this format MM/DD/YYYY: |
| Enter date in this format MM/DD/YYYY: |
| Enter date in this format MM/DD/YYYY: |
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