Attachment 5 - ARS-372.pdf
PDF 89 KB Posted
- Attached to
- Caliche Road Improvements Federal contract opportunity
- Solicitation number
- 12805B21R0010
About this file
This document contains a contractor payment request form and information about a federal contract solicitation for caliche road improvements. The payment request form is for contract number ARS-372 and includes fields for the original contract amount, change orders, adjusted contract price, value of work completed, stored materials, previous payments, and net amount due. The related solicitation is number 12805B21R0010 from the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area for caliche road improvements at the USDA ARS Cattle Fever Tick Research Laboratory in Edinburg, Texas. A mandatory site visit will be held on July 19, 2021 for interested contractors to inspect the road work locations prior to submitting a response.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 2021.07.29 - Additional Questions and Answers.pdf | ||
| 2021.07.29 - Questions and Answers.pdf | ||
| Site Visit Sign-In Roster Caliche Rd.pdf | ||
| 2021.07.23 - Questions and Answers.pdf | ||
| Solicitation - 12805B21R0010.pdf | ||
| Attachment 3 - Map where caliche and chip seal is needed.pdf | ||
| Solicitation - 12805B21R0010.pdf | ||
| Attachment 1 - Wage Determination TX20210027.pdf | ||
| Attachment 2 - SOW-CFTRL Caliche Road Improvement v1.pdf | ||
| Attachment 4 - ARS-371.pdf | ||
| Attachment 6 - Bond Forms.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 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
File details come from the government source that posted it. Updated .