Attachment H - ARS-372.pdf
PDF 30 KB Posted
- Attached to
- Construct Grassed Waterways - Temple, TX Federal contract opportunity
- Solicitation number
- 12805B23Q0501
About this file
This document is a contractor's request for payment transmittal form for a federal construction contract. The form provides line items to request payment for work completed on Construct Grassed Waterways in Temple, Texas under Solicitation Number 12805B23Q0501 issued by the Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Plains Area. Key details include line items for the original contract amount, change orders, total adjusted contract price, value of work completed, stored materials, retainage percentage, previous payments made, and the net payment due. Spaces are provided for the contractor's authorized representative and government officials to sign off recommending and concurring with the requested payment.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| REVISED Questions.docx | DOCX document | |
| REVISED Clauses and Provisions - Temple Grassed Waterways.docx | DOCX document | |
| Questions.docx | DOCX document | |
| Clauses and Provisions - Temple Grassed Waterways.docx | DOCX document | |
| Attachment F - Statement of Work.docx | DOCX document | |
| Attachment A Temple North Field Drawing.pdf | ||
| Attachment D Grassed Waterway Specification.pdf | ||
| Attachment G - ARS-371.pdf | ||
| Attachment B Temple South Field Drawing.pdf | ||
| Attachment E Construction Packet.pdf | ||
| Attachment C Grassed Waterway Standard.pdf | ||
| Attachment I - Bid Schedule.xlsx | XLSX spreadsheet | |
| Attachment J - Wage Determination - Bell County.pdf |
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 .