Attachment 05 ARS 372.pdf
PDF 30 KB Posted
- Attached to
- Boiler House - Boiler #3 Platform Improvements Federal contract opportunity
- Solicitation number
- 12505B25R0001
About this file
This document is a Contractor's Request for Payment Transmittal form, which is used by contractors to request progress payments under a federal contract. The form includes details such as the contract number, project location, partial payment number, and requisition number. It also includes line items for the original contract amount, change orders, total adjusted contract price, value of work completed, value of stored materials, total value of work and stored materials, percentage of retainage, and the net amount due to the contractor for the current payment request.
The related federal contract opportunity is for Boiler House - Boiler #3 Platform Improvements at the USDA Agricultural Research Service's National Center for Agricultural Utilization Research in Peoria, IL. This is a small business set-aside solicitation with a NAICS code of 238220 (Plumbing, Heating, and Air Conditioning Contractors) and a size standard of $19.0 million. The magnitude of construction is between $25,000 and $100,000, and the period of performance is 120 days after the Notice to Proceed is issued. A site visit is scheduled for November 21, 2024, and all questions must be submitted by December 2, 2024.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 12505B25R0001 Amendment 00001.pdf | ||
| Attachment 7 Site Visit Sign In Sheet.pdf | ||
| RFQ 12505B25R0001 Boiler Platform Repair.pdf | ||
| Attachment 01 Wage Determination IL20240003 18 Oct 24.pdf | ||
| RFQ 12505B25R0001 Boiler Platform Repair.pdf | ||
| Attachment 02 Statement of Work.pdf | ||
| Attachment 04 ARS 371.pdf | ||
| Attachment 01 Wage Determination IL20240003 18 Oct 24.pdf | ||
| Attachment 03 Quality Assurance Surveillance Plan.pdf | ||
| Attachment 06 Past Performance Questionnaire.docx | DOCX document |
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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.: |
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| Contractor's request for payment transmittal. Enter contract number.: |
| Partial payment number.: |
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| Requisition number.: |
| Location.: |
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| Enter date in this format MM/DD/YYYY: |
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