Attach_3_Invoicing.pdf

Solicitation or Award Number: 140R2020R0010 Page 1 of 2

WBR 1432.903-1a Construction Payment (03/2019)

In accordance with Reclamation Acquisition Regulations WBR 1432.903(c)(2), this form is required for awards that will be invoiced through Reclamation’s Invoicing SharePoint Site (non-IPP).

INVOICE (Construction)

Request Payment No. _____ ☐ Progress (__% Complete) ☐ Final ☐ Small Business/QuickPay Invoice Date: _____________ ☐ Prime Contractor/QuickPay with subcontractors

INVOICE PERIOD (MO/YR): CONTRACT NO.

CONTRACT TITLE:

CONTRACTOR NAME:

CONTRACTOR ADDRESS:

NAME/TITLE/ADDRESS/PHONE # OF PERSON TO NOTIFY IN EVENT OF DEFECTIVE INVOICE:

INVOICE AMOUNT:

1. PRIME CONTRACTOR:

2. SUBCONTRACTOR:

3. OTHER:

4. INVOICE TOTAL:

PAYMENT METHOD: Electronic Fund Transfer (EFT)

CONTRACTOR’S PAYMENT CERTIFICATION:

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 their subcontract agreements and the requirements of Chapter 39 of Title 31, United States Code; and (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 (4) This certification is not to be construed as final acceptance of a subcontractor’s performance.

AUTHORIZED SIGNATURE: _____________________________________________________

Name/Title: _____________________________________________ Date: __________________

Solicitation No. 140R2019R0017 - Antioch Fish Release Site Replacement

Solicitation or Award Number: 140R2020R0010 Page 2 of 2

WBR 1432.903-1a Construction Payment (03/2019)

SPACE BELOW THIS LINE TO BE COMPLETED BY BUREAU OF RECLAMATION

AND SIGNED BY THE CONTRACTING OFFICER’S REPRESENTATIVE (COR)

Date Invoice Received:

( ) Invoice certified correct for payment in the amount of $ as shown on

CONTRACT SUMMARY AND VOUCHER, ESTIMATE NO. Month of

( ) Invoice certified correct for payment in the amount of $

Certified Correct by:

(Signature) (Title) (Date

Page 1 of X

Invoice Period (Month/Year): ___________________ Contract Number: ____________

Subcontractors:

SF-1413 on file - to be checked by Agency

Subcontractor Name

Subcontractor Contract Amount with Prime Contractor

Amount Previously Paid

Amount Paid from this Invoice Adjustment

TOTAL

PAID

Suppliers:

Supplier Estimated Contract Amount With Prime Contractor

Amount Previously Paid

Amount Paid from this Invoice Adjustment

TOTAL

PAIDSupplier Name

WBR 1432.903-1b Subcontractor / Supplier Payment Summary Version Date 03/2019

Solicitation or Award Number: 140R2020R0010

Page 1 of X

WBR 1432.903-1b Subcontractor / Supplier Payment Summary Version Date 03/2019

Solicitation or Award Number: 140R2020R0010