Attachment 7 ARS-372 - CONTRACTOR REQUEST FOR PAYMENT TRANSMITTAL.pdf
PDF 30 KB Posted
- Attached to
- Pendleton Building Repairs Project E (Adams, OR) Federal contract opportunity
- Solicitation number
- 1232SA26Q0209
About this file
This is a Contractor's Request for Payment Transmittal form (Form ARS-372, 06/2011) used by the USDA Agricultural Research Service for processing progress and final payments on federal contracts. The form serves as a template for contractors to document and request payment for work completed during specified periods.
The form requires contractors to itemize the original contract amount, any change orders or amendments, and calculate the total adjusted contract price. Contractors must report the value of work completed to the end of the period and the value of any materials stored at the site, with a detailed breakdown of stored materials. Line items guide calculation of total value, application of retainage percentages, deduction of previous payment requests, and determination of the net amount due. The form includes a Contractor's Progress Payment Certification section in which the contractor certifies that: (1) amounts requested are only for performance in accordance with contract specifications; (2) all payments to subcontractors and suppliers from previous payments have been made and timely payments will be made from current proceeds in accordance with Chapter 39 of Title 31, United States Code; (3) no amounts are being withheld from subcontractors or suppliers beyond subcontract terms; and (4) the certification does not constitute final acceptance of subcontractor performance. The form requires signatures from the contractor's authorized representative, the appropriate government representative (EPM, COR, CM, or A-E) for payment recommendation, and concurrence from the EPM or COR, with corresponding dates for each signature.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| SF30_1232SA26Q0209_0002.pdf | ||
| Questions_and_Answers_1232SA26Q0209.pdf | ||
| Site Visit Sign-In Sheet.pdf | ||
| SF30_1232SA26Q0209_0001.pdf | ||
| Attachment 1 - Solicitation Terms and Conditions_1232SA26Q0209.pdf | ||
| Attachment 2 Specifications.pdf | ||
| Attachment 4 Structural Calculations.pdf | ||
| Attachment 3 Drawings.pdf | ||
| Attachment 6 ARS-371 - CONSTRUCTION PROGRESS AND PAYMENT SCHEDULE.pdf | ||
| Attachment 5 - DOL OR20260089_2026_01_02.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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