Attachment 6 - ARS-372 Request for Payment.pdf
PDF 72 KB Posted
- Attached to
- Drill Water Well For Livestock Federal contract opportunity
- Solicitation number
- 1232SA25Q0347
About this file
The document is a USDA Agricultural Research Service (ARS) Contractor's Request for Payment Transmittal form (ARS-372), designed to capture detailed financial information for a contract payment. The form allows contractors to document the original contract amount, change orders, total adjusted contract prices, value of work completed, materials stored on-site, and calculates the net amount due for the current payment period. The form includes a progress payment certification section where the contractor must affirm that payments are in accordance with contract specifications, all subcontractor payments have been made, and the request does not include any withheld subcontractor funds. Signature lines are provided for the contractor's authorized representative, and for recommendation and concurrence by appropriate project management personnel.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 1 - Statement of Work.pdf | ||
| Attachment 3 - Bond Forms.pdf | ||
| RFP__1232SA25Q0374.pdf | ||
| Attachment 5 - ARS 371 Construction Progress and Payment Schedule.pdf | ||
| Attachment 2 - Wage Determination.pdf | ||
| Attachment 4 - Contractor Certification Regarding EMR.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 -
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