ARS372.pdf
PDF 24 KB Posted
- Attached to
- Mayaquez Underground Electrical Distribution Federal contract opportunity
- Solicitation number
- 12405B21R0002
About this file
This document contains a contractor payment request form and information on a federal contract opportunity for installation of an underground electrical distribution system. The payment request form is for Contract No. XX and includes fields for the original contract amount, change orders, total adjusted price, work completed to date, stored materials, total value of work and materials, previous payments, and the net amount due. The federal contract opportunity is issued by the USDA Agricultural Research Service for installation of an underground electrical distribution system at the Mayaguez Tropical Agriculture Research Station in Puerto Rico. Interested small businesses in NAICS code 238210 must attend a scheduled site visit and submit proposals to the named Contracting Officer by email by the specified deadline. The requirement includes attached drawings and specifications and has a set-aside for qualified small businesses.
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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 CERTIFICATION OF PAYMENT
By signing this request for payment, I certify that I have made payment from the proceeds of prior payments, and that I will make timely payment from the proceeds of this payment, of amounts due my subcontractors and suppliers in accordance with my contractual arrangements with them.
SIGNATURE OF CONTRACTOR'S AUTHORIZED REPRESENTATIVE
RECOMMENDED FOR PAYMENT (Signature of EPM, COR, CM or A.E. as ppropriate)
CONCUR (Signature of EPM or COR as appropriate)
DATE SIGNED
DATE SIGNED
DATE SIGNED
Form ARS-372 (11/84) Replaces SEA-372 (1/79) which may be used. USDA-ARS This form was electronically produced by USDA/ARS/OCIO/ADB.
% retainage
| RFP - TOC USNA FH.pdf |
| SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS |
File details come from the government source that posted it. Updated .