Attachment 5 ARS-372 - CONTRACTOR REQUEST FOR PAYMENT TRANSMITTAL.pdf
PDF 30 KB Posted
- Attached to
- Remove & Replace 3 & 4-Ton Mini Splits (Fort Lauderdale, FL) Federal contract opportunity
- Solicitation number
- 1232SA26Q0207
About this file
This is a USDA-ARS Contractor's Request for Payment Transmittal form (ARS-372) used to document progress payments on federal contracts. The form serves as the official documentation for contractors to request partial or final payments based on work completed during a specified period.
The form requires contractors to provide: the original contract amount, any change orders or amendments, the total adjusted contract price, the value of work completed to the end of the period, the value of materials stored at the site, a total value combining completed work and stored materials, applicable retainage deductions, the cumulative amount due through the current period, previous payment requests, and the net amount due for the current payment. Contractors must certify that amounts requested correspond only to work performed in accordance with contract specifications and terms; that all previous payments to subcontractors and suppliers have been made timely; that no amounts are being withheld from subcontractors or suppliers beyond subcontract terms; and that the certification does not constitute final acceptance of subcontractor performance. The form requires three signatures: the contractor's authorized representative, the recommending official (EPM, COR, CM, or A-E), and a concurrent signature from the EPM or COR, each with corresponding dates signed.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| SF30_1232SA26Q0207_0002.pdf | ||
| Questions_Answers_1232SA26Q0207.pdf | ||
| Copy of Site Visit Sign-in Sheet.pdf | ||
| SF30_1232SA26Q0207_0001.pdf | ||
| Attachment 2 Statement of Work.pdf | ||
| Attachment 3 - DOL FL20260197_2026_01_02.pdf | ||
| Attachment 4 ARS-371 - CONSTRUCTION PROGRESS AND PAYMENT SCHEDULE.pdf | ||
| Attachment 1 - Solicitation Terms and Conditions_1232SA26Q0207.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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| Contractor's request for payment transmittal. Enter contract number.: |
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| Enter date in this format MM/DD/YYYY: |
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| Enter date in this format MM/DD/YYYY: |
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