Attachment G - BLANK SAMPLE AF Form 3065.xlsx
XLSX spreadsheet 49 KB Posted
- Attached to
- Robins AFB Paving Multi-Award IDIQ
- Solicitation number
- FA850126R0004
About this file
This file is a blank template for the AF Form 3064 (Contract Progress Schedule) and AF Form 3065 (Contract Progress Report), which are standard Department of Defense forms used to track contractor progress on construction projects. The forms are designed for use at Robins Air Force Base, Georgia, and include fields for contract number (FA8501-XX-X-XXXX format), project title, starting and completion dates, and actual performance dates. The AF Form 3064 provides a Gantt chart-style schedule with line items for work elements organized by Contract Line Item Numbers (CLINs), showing monthly progress tracking from August through March with percentage completion columns. The AF Form 3065 allows contractors to report progress during specified reporting periods, capturing the percentage of total job completion, completion achieved in the current period, and cumulative completion percentages for up to 44 work elements.
These forms are used for contract administration and payment certification purposes. The AF Form 3064 requires signatures from the contractor, the installation's engineer, the contracting officer, and approval from the appropriate authority. The AF Form 3065 includes a Progress or Completion Certificate to be certified by the project manager and reviewed by the contracting officer, confirming satisfactory completion according to contract specifications. Both forms are approved under OMB Number 0704-0188 and are designed to support the computation of progress payments in accordance with contract payment clauses. As templates, these forms contain placeholder data and error values indicating they are blank samples ready for completion on actual contracts.
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Text version
AF Form 3064 CONTRACT PROGRESS SCHEDULE (See Contractor's Instructions on Reverse) Form Approved OMB NO. 0704-0188
| 1. CONTRACT NO. | 8. PROJECT TITLE | 10. APPROVAL RECOMMENDED BY | |
| FA8501-XX-X-XXXX | Project Title, Robins AFB, GA | DATE SIGNED | INSTALLATION'S ENGINEER'S SIGNATURE |
| 2. STARTING DATE/ NTP | X/XX/2017 | 9. SUBMITTED BY: | ||||||||||||
| 3. COMPLETION DATE | ERROR:#VALUE! | DATE SIGNED | CONTRACTOR'S NAME (LAST, FIRST, I) ADDRESS (STREET, CITY, STATE, ZIP) | CONTRACTOR'S SIGNATURE | 11. APPROVED BY | |||||||||
| 4. PURCHASE REQUEST NO. | DATE SIGNED | CONTRACTING OFFICER'S SIGNATURE | ||||||||||||
| 5. PROJECT NO. | XXXXXX | |||||||||||||
| 6. ACTUAL STARTING DATE | X/XX/2017 | |||||||||||||
| 7. ACTUAL COMP DATE | ||||||||||||||
| LINE NO. | WORK ELEMENTS | XXXXXX.XX | % | |||||||||||
| A | XXXXX.XX | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | X/X/2017 | ||||
| 1 | CLIN 1 | |||||||||||||
| ERROR:#VALUE! | ||||||||||||||
| 2 | ||||||||||||||
| ERROR:#VALUE! | ||||||||||||||
| 3 | ||||||||||||||
| ERROR:#VALUE! | ||||||||||||||
| 4 | ||||||||||||||
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| 5 | ||||||||||||||
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| 6 | ||||||||||||||
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| 7 | ||||||||||||||
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| 8 | ||||||||||||||
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| 9 | ||||||||||||||
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| 10 | ||||||||||||||
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| 11 | ||||||||||||||
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| 12 | ||||||||||||||
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| 13 | ||||||||||||||
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| 14 | ||||||||||||||
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| 15 | ||||||||||||||
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| 16 | ||||||||||||||
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| 17 | ||||||||||||||
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| 18 | ||||||||||||||
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| 19 | ||||||||||||||
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| 20 | ||||||||||||||
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| 21 | ||||||||||||||
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| 22 | ||||||||||||||
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| 23 | ||||||||||||||
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| 24 | ||||||||||||||
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| 25 | ||||||||||||||
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| 26 | ||||||||||||||
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| 27 | ||||||||||||||
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| 28 | ||||||||||||||
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| 29 | ||||||||||||||
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| 30 | ||||||||||||||
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| 31 | ||||||||||||||
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| 32 | ||||||||||||||
| ERROR:#VALUE! | ||||||||||||||
| 33 | ||||||||||||||
| ERROR:#VALUE! | ||||||||||||||
| 34 | ||||||||||||||
| ERROR:#VALUE! | ||||||||||||||
| 35 | ||||||||||||||
| ERROR:#VALUE! | ||||||||||||||
| 36 | ||||||||||||||
| ERROR:#VALUE! | ||||||||||||||
| Total | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | ||||
| 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | ERROR:#VALUE! | |||||
| 37 | CLIN 2 | |||||||||||||
| Fence | 20 | 2.17% | ERROR:#VALUE! | |||||||||||
| ERROR:#VALUE! |
&"Arial,Bold"&8AF FORM 3064, JUN 90 &"Arial,Bold Italic"&6 PREVIOUST EDITION IS OBSOLETE
AF Form 3065
CONTRACT PROGRESS REPORT OMB NO. 0704-0188
| CONTRACTOR | ADDRESS | ||||||||
| 0 | |||||||||
| 0 | |||||||||
| REPORT NO. | PERIOD COVERED | PROJECT NO. | CONTRACT NO. | COMPLETION DATE | |||||
| 1 | FROM: | TO: | XXXXXX | FA8501-XX-X-XXXX | |||||
| LINE NO. | WORK ELEMENT | % OF TOTAL JOB | % COMPLETED THIS PERIOD | % COMPLETED CUMULATIVE | |||||
| 1 | 0.00% | 0.00% | 0.00% | ||||||
| 2 | 0.00% | 0.00% | 0.00% | ||||||
| 3 | 0.00% | 0.00% | 0.00% | ||||||
| 4 | 0.00% | 0.00% | 0.00% | ||||||
| 5 | 0.00% | 0.00% | 0.00% | ||||||
| 6 | 0.00% | 0.00% | 0.00% | ||||||
| 7 | 0.00% | 0.00% | 0.00% | ||||||
| 8 | 0.00% | 0.00% | 0.00% | ||||||
| 9 | 0.00% | 0.00% | 0.00% | ||||||
| 10 | 0.00% | 0.00% | 0.00% | ||||||
| 11 | 0.00% | 0.00% | 0.00% | ||||||
| 12 | 0.00% | 0.00% | 0.00% | ||||||
| 13 | 0.00% | 0.00% | 0.00% | ||||||
| 14 | 0.00% | 0.00% | 0.00% | ||||||
| 15 | 0.00% | 0.00% | 0.00% | ||||||
| 16 | 0.00% | 0.00% | 0.00% | ||||||
| 17 | 0.00% | 0.00% | 0.00% | ||||||
| 18 | 0.00% | 0.00% | 0.00% | ||||||
| 19 | 0.00% | 0.00% | 0.00% | ||||||
| 20 | 0.00% | 0.00% | 0.00% | ||||||
| 21 | 0.00% | 0.00% | 0.00% | ||||||
| 22 | 0.00% | 0.00% | 0.00% | ||||||
| 23 | 0.00% | 0.00% | 0.00% | ||||||
| 24 | 0.00% | 0.00% | 0.00% | ||||||
| 25 | 0.00% | 0.00% | 0.00% | ||||||
| 26 | 0.00% | 0.00% | 0.00% | ||||||
| 27 | 0.00% | 0.00% | 0.00% | ||||||
| 28 | 0.00% | 0.00% | 0.00% | ||||||
| 29 | 0.00% | 0.00% | 0.00% | ||||||
| 30 | 0.00% | 0.00% | 0.00% | ||||||
| 31 | 0.00% | 0.00% | 0.00% | ||||||
| 32 | 0.00% | 0.00% | 0.00% | ||||||
| 33 | 0.00% | 0.00% | 0.00% | ||||||
| 34 | 0.00% | 0.00% | 0.00% | ||||||
| 35 | 0.00% | 0.00% | 0.00% | ||||||
| 36 | 0.00% | 0.00% | 0.00% | ||||||
| 37 | 0.00% | 0.00% | 0.00% | ||||||
| 38 | 0.00% | 0.00% | 0.00% | ||||||
| 39 | 0.00% | 0.00% | 0.00% | ||||||
| 40 | 0.00% | 0.00% | 0.00% | ||||||
| 41 | 0.00% | 0.00% | 0.00% | ||||||
| 42 | 0.00% | 0.00% | 0.00% | ||||||
| 43 | 0.00% | 0.00% | 0.00% | ||||||
| 44 | 0.00% | 0.00% | 0.00% | ||||||
| TOTAL | 0% | 0% | 0% | ||||||
| REMARKS | |||||||||
| Construction Inspector: Print Name ______________________ Signature: | |||||||||
| Date |
| At the Contracting discretion and according to the payments clause of the contract, the information provided on this form may be used for computing progress payments. | ||
| PROGRESS OR COMPLETION CERTIFICATE | ||
| I hereby certify that the contractor has satisfactorily completed the indicated percentage of the contract per contract specs. | ||
| SUBMITTED BY OR FOR |
| TYPED NAME AND TITLE | SIGNATURE | DATE |
| Project Manager |
| REVIEWED BY OR FOR CONTRACTING OFFICER | ||
| TYPED NAME AND TITLE | SIGNATURE | DATE |
CONTRACTOR
78th CIVIL ENGINEERS
Sheet1
| % COMPLETED THIS PERIOD |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| ERROR:#REF! |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| 0.00% |
| ERROR:#REF! |
Sheet2
Microsoft_Word_97_-_2003_Document.doc Public reporting burden for this collection of information is estimated to average 15 minutes per response including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of the collection of information including suggestions for reducing this burden in Department of Defense, Washington Headquarters Service. Directorate for information Operations and Report. 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22292-4302, and to the Office of Management and Budget, Paperwork Reduction Project 0704-0188, Washington, DC 20503. Please DON NOT RETURN your (form questionnaire) to either of these addresses. Send your completed (form questionnaire) to: SAF AQCO, Washington, DC 20330-1000.
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