Attachment 5 ARS-372.pdf

PDF 30 KB Posted

Attached to
Repair Insulation Bldg 24 Federal contract opportunity
Solicitation number
12805B24Q0075
Issued by
Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area

About this file

This document contains a contractor's request for payment transmittal form and information regarding a federal contract opportunity for repairing insulation at Building 24. The payment transmittal form outlines items including the original contract amount, change orders, total adjusted price, work completed to date, stored materials, retainage percentage, previous payments made, and the net amount due. Contractors must attend a mandatory site visit on either January 17th or 25th, 2023 to be eligible to bid on the repair insulation opportunity at the USDA Agricultural Research Service facility in Bushland, Texas. The solicitation number is 12805B24Q0075 and bids are due by the site visit registration deadline of January 16, 2024. The opportunity type is for a solicitation to repair building insulation and registration is required to attend one of the two scheduled site visits in order to submit an offer.

View the file

Other files for this federal contract opportunity

Show all 13

On GovTribe

Work with this file on GovTribe

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

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.:
Value. Line 1.:
Value. Line 2.:
Value. Line 3.:
Value. Line 4.:
Value. Line 5.:
Value. Line 6.:
Value. Line 7.:
Value. Line 8.:
Value. Line 9.:
Contractor's request for payment transmittal. Enter contract number.:
Partial payment number.:
Project.:
Requisition number.:
Location.:
Description. Line 1.:
Description. Line 2.:
Description. Line 3.:
Description. Line 4.:
Description. Line 5.:
Description. Line 6.:
Description. Line 7.:
Description. Line 8.:
Description. Line 9.:
Value. Line 10.:
Value. Line 11.:
Value. Line 12.:
Value. Line 13.:
Value. Line 14.:
Value. Line 15.:
Value. Line 16.:
Value. Line 17.:
Description. Line 10.:
Description. Line 11.:
Description. Line 12.:
Description. Line 13.:
Description. Line 14.:
Description. Line 15.:
Description. Line 16.:
Description. Line 17.:
Enter date in this format MM/DD/YYYY:
Enter date in this format MM/DD/YYYY:
Enter date in this format MM/DD/YYYY:

File details come from the government source that posted it. Updated .