Attachment 4 ARS_372_REQUEST FOR PAYMENT TRANSMITTAL.pdf
PDF 30 KB Posted
- Attached to
- Standby Generators USDA ARS Salinas, CA Federal contract opportunity
- Solicitation number
- 12905B23Q0193
About this file
This document is a contractor's request for payment transmittal form for a federal construction contract. The form provides line items to input the original contract amount, any change orders or amendments, the adjusted total contract price, the value of work completed to date and stored materials, amounts due and previously paid, and the net payment amount due. It requires signatures from the contractor and approving officials at the contracting agency, the USDA Agricultural Research Service, to certify performance in accordance with specifications and that proper payments have been made to subcontractors and suppliers. The related federal contract opportunity is solicitation number 12905B23Q0193 for standby generators at the USDA ARS facility in Salinas, California, issued by the Department of Agriculture Agricultural Research Service Pacific West Area.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 12905B23Q0193 Amendment 0003.pdf | ||
| Attachment 6 Additional Photos.pdf | ||
| Attachment 5 Questions and Answers for Standby Generators in Salinas Ver 2.pdf | ||
| 12905B23Q0193 Amendment 0002.pdf | ||
| Attachment 5 Questions and Answers for Standby Generators in Salinas.pdf | ||
| SF_18_12905B23Q0193_RFQ.pdf | ||
| Attachment 1 Statement of Work.pdf | ||
| Attachment 3 ARS_371_CONSTRUCTION PROGRESS AND PAYMENT SCHEDULE.pdf | ||
| 12905B23Q0193 Amendment 00001.pdf | ||
| Attachment 2 Wage Determination CA20230018 dated 7_28_2023.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.: |
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| Enter date in this format MM/DD/YYYY: |
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