Attachment J-12 - Appendix F - 2023 FTA PMOC Invoice Template V1.2.0 - Final.pdf

RFP Number 69319524R000001

Attachment J-12 Appendix F - 2023 FTA PMOC

Invoice Template V1.2.0

STEP 4: Enter Approved FTA Labor Categories

Labor Category Firm Firm Acronym

Prime/Sub/Co nsultant Mod Indirect Cost # G&A Rate OH Rate Fringe FCCM Fee Rate

Contractor: - - 0.00%

Taxpayer I.D. Number:

Bank info for deposit:

Invoice Contact Name:

Invoice Contact Email:

PMO CONTRACT No.:

FTA CO:

Contract Period of Performance Start Date:

Contract Period of Performance End Date:

Firm Prime/Sub/Consultant Firm Acronym

STEP 3: Enter Approved Personnel and Select Firm

Personnel Firm Firm Acronym

STEP 5: Select Firm Name and Enter applicable G&A OH, Fringe, FCCM, & Fee Rates.

Enter Yellow Highlighted columns first Orange columns are dropdown selections Green columns are populated automatically

Personnel Names MUST be Unique!!

Address:

Contract and PMOC Information

STEP 2: Enter Firm Name, Firm Acronym, Sub/Prime

STEP 1 : Enter Contract Information below.

Orange columns are dropdown selections Green columns are populated automatically

Rates are Invoiced Rates (Either Labor Category Threshold rates or audited employee rates, generally the lower of these rates)

Task Order Number: Invoice Labor Rates and Firm Info Summary Table

Task Order Description: LaborCategory Personnel Firm Acronym Prime/Sub/Consultant YR1 Rate YR2 Rate YR3 Rate

Invoice Period of Performance Start Date: - - -

Invoice Period of Performance End Date: - - -

Invoice No. 1

PMOC Invoice #

Invoice Revision

Invoice Date:

FTA COR:

FTA ACOR

Region / HQ

Task Order Period of Performance Start Date:

Task Order Period of Performance End Date: Default Directory:

STEP 7: Add projects as required and enter project name. C:\Users\Aaron\OneDrive - EBI Management Group, Inc\Desktop

Project Number Project Name

1 Project 1

Task Order Information

Enter Yellow Highlighted columns first

STEP 6: Enter Task Order Information below.

Select Labor

Enter Fee RSTEP 8: Enter Fee Rate, Select Labor Rate Year, and complete Labor Rate table below for any employee or subcontractor that will appear on the current invoice.

STEP 9: Enter Fixed Fee Withholding.

Order/Mod No.

Withholding of Fixed Fee

Threshold Award CLIN Labor Hours Allotted to Cost Allotted to Fee CPFF Notes Award CLIN Labor Hours Allotted to Cost Allotted to Fee CPFF Notes

Base H.2 TOTAL 1 - -$ -$ -$ B TOTAL 1 - -$ -$ -$

Total -$ H.2 TOTAL 2 - -$ -$ -$ B TOTAL 2 - -$ -$ -$

H.2 TOTAL 3 - -$ -$ -$ B TOTAL 3 - -$ -$ -$

H.2 TOTAL 4 - -$ -$ -$ B TOTAL 4 - -$ -$ -$

H.2 TOTAL 5 - -$ -$ -$ B TOTAL 5 - -$ -$ -$

TOTAL ALL CLINS - -$ -$ -$ TOTAL ALL CLINS - -$ -$ -$

Award CLIN Labor Hours Allotted to Cost Allotted to Fee CPFF Notes Award CLIN Labor Hours Allotted to Cost Allotted to Fee CPFF Notes

BASE 1 -$ BASE 1 -$

BASE 2 -$ BASE 2 -$

BASE 3 -$ BASE 3 -$

BASE 4 -$ BASE 4 -$

BASE 5 -$ BASE 5 -$

SUBTOTAL ALL CLINS - -$ -$ -$ SUBTOTAL ALL CLINS - -$ -$ -$

Green columns are populated automaticallyEnter Yellow Highlighted columns first

STEP 10: Complete H.2 Table Information as awards are approved. STEP 11: Complete B Table Information as awards are approved.

Orange columns are dropdown selections

H.2 Table Summary B Table SummaryFixed Fee Withholding Details

PROJECT LEVEL COST BREAKDOWN

Invoice #: 1 CLIN LOE (Hours) LOE for Fixed Fee (Hours) Labor G&A Overhead Fringe Subtotal Billed Fixed Fee Withholding of Fixed

Fee Fee Withholding

Adjustment FCCM Net Invoice Change in

(Billed)/Unbilled Fixed Fee

Unbilled LOE for Fixed Fee Hours

Unbilled LOE for Fixed Fee Dollars

Contractor: CLIN 1 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Billing Period Start Date: CLIN 2 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Billing Period End Date: CLIN 3 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Invoice Date: CLIN 4 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

CLIN 5 $ - $ - $ -

Task Order: CLIN 1 - 5 Totals $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Project Number: 1 Prime Totals $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Project Name: Project 1 Subcontractor Totals $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Project Phase: Project Development Consultant Totals $ - $ - $ - $ -

Travel and ODC $ - $ - Labor Rate: YR1 Rate TOTALS $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

SECTION A: CLIN 1-4 DETAILS

Drop Down Drop Down Entry Cells Subtotals FCCM Invoice Totals

Personnel LCAT CLIN Firm Prime/Sub/ Consultant Description LOE (Hours) LOE for Fixed Fee

(Hours) Indirect Cost # Override Labor Rate Rate Labor G&A Overhead Fringe Subtotal Billed Fixed Fee Withholding of Fixed Fee

Fee Withholding Adjustment FCCM Net Invoice

Change in (Billed)/Unbilled Fixed

Fee

CLIN 1 - 4 TOTALS $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

SECTION A: CLIN 1-4 FEE FROM PRIOR INVOICE

Entry Cells Drop Down Entry Cells

Prior Invoice Number OP Number (Optional) CLIN Firm Prime/Sub Description/Report Name/Deliverable ACOR Approval LOE for Fixed Fee

(Hours) Billed Fixed Fee Withholding of Fixed Fee

Fee Withholding Adjustment Net Fee Billing

Change in (Billed)/Unbilled Fixed

Fee

SECTION B: CLIN 5 DETAILS

Drop Down Entry Cell CLIN 5 Drop Down

Personnel TAR Number CLIN Firm Prime/Sub/ Consultant

Travel Date OR Non-Travel ODC Desc Approval Date City State Trip#/ODC TAR or ODCs

Estimated Amount Amount

CLIN 5 - -

Totals -$ -$

Unbilled LOE for Fixed Fee

Entry Cells Fixed Fee & RetainageCost Components

FEE FROM PRIOR INVOICE TOTALS

CLIN 1-5 SUMMARY TABLE

Entry Cells Entry Cells

Drop Down Entry Cells

Firm Details

Firm Details

INVOICE OVERVIEW

Contractor: 0 FEE BILLING DETAILS Invoice Billed LOE (Hours)

Billed LOE for FF (Hours) Billed Fee Withholding of

FF Net Fee Billed Unbilled LOE for FF (hours)

Unbilled Fixed Fee (Dollars)

0 $ -

0 Total 0.0 0.0 $ - $ - $ - 0.0 $ -

Taxpayer I.D. Number: 0 0 0.00 -$ Bank info for deposit: 0

Invoice Contact Name: 0

Invoice Contact Email: 0

PMO CONTRACT No.: 0

FTA CO: 0

FTA COR: 0

Invoice Period of Performance Start Date: 01/00/1900

Invoice Period of Performance End Date: 01/00/1900

Invoice No. 1

Invoice Date: 01/00/1900

Task Order Number Task Order Expiration

Date 0 1/0/1900

Project Number Project Name FTA ACOR LOE this Invoice

Subtotal Billed this Invoice Fixed Fee Withholding of

Fixed Fee Fee

Adjustment FCCM Net Invoice Amount

1 Project 1 0 - -$ -$ -$ -$ -$ -$

NOTE: Invoice Overview Format Applies to both Headquarter's and Regional Task Orders

CLIN 1 CLIN 2 CLIN 3 CLIN 4 CLIN 5 Total

EINVOICING RECAP

eInvoice Entry

FEE BILLING DETAILS

Address:

FTA COR

Total Billed This Period

1/0/1900

Task Order Description

Contractor 0

Invoice No.:

Invoice Date: 01/00/00

Task Order Number Task Order Description Task Order Dollars

Not-to-Exceed Authorized

Task Order Hours Not-to-

Exceed Authorized

Task Order Dollars Funded to Date

Task Order Hours Funded to Date

Budgetary Dollars Allocated From H.2

Table

Budgetary Hours Allocated From H.2

Table

Dollars Billed to Date *

Hours Billed to Date

H.2 Balance Available

H.2 Hours Available

Funds Billed To Date (%)

Hours Billed To Date (%)

0 0 $ - - $ - - $ - - $ - - $ - - #DIV/0! #DIV/0!

Project Number Project Name IIP/Budgetary Dollars

Allocated From H.2 Table

IIP/Budgetary Hours Allocated From H.2 Table

Dollars Accrued Previously *

Hours Billed Previously

Dollars Accrued This Period *

Hours Billed This Period

Total Dollars Accrued to Date *

Total Hours Billed to Date

IIP/Budgetary Balance

Remaining

IIP/Budgetary Hours

Remaining

Funds Billed To Date (%)

Hours Billed To Date (%)

1 Project 1 $0.00 0.00 $0.00 0.00 $ - 0.00 $ - 0.00 0.00% 0.00%

Total $ - 0.00 $0.00 0.00 $ - 0.00 $ - 0.00 $ - 0.00 0.00% 0.00%

Not-to-Exceed (Allotted to Fee) Billed Previously Billed This Period Billed to Date Balance Remaining Billed To

Date (%)

Level of Effort Fee -$ -$ -$ -$

Withholding of Fixed Fee -$ -$ -$ -$

Fee Less Withholding -$ -$ -$ -$ 0.00%

Fee Summary

INVOICE BREAKDOWN

B Table H.2 Table

* includes fixed fee regardless of deliverable acceptance and does not include associated withholding of fixed fee.

IIP

Invoice No. 1

Invoice Date: 01/00/1900

CLIN CLIN Description T.O. Dollars Accrued Previously *

T.O. Hours Billed Previously

T.O. Dollars Accrued This Period *

T.O. Hours Billed This Period

T.O. Dollars Accrued to Date *

T.O. Hours Billed to Date

TO Withholding Billed to Date

TO Billed to Date with Fixed Fee (less Withholding to date)

1 Program Support and Lessons Learned $ - 0.00 $ - 0.00 $ - 0.00 $ - $ -

2 On-Site Monitoring and Reporting $ - 0.00 $ - 0.00 $ - 0.00 $ - $ -

3 Baseline Oversight $ - 0.00 $ - 0.00 $ - 0.00 $ - $ -

4 Optional Oversight $ - 0.00 $ - 0.00 $ - 0.00 $ - $ -

5 Travel and Other Direct Costs $ - 0.00 $ - 0.00 $ - 0.00 $ -

$ - 0.00 $ - 0.00 $ - 0.00 $ - $ -

Project 1: Project 1

CLIN CLIN Description T.O. Dollars Accrued Previously *

T.O. Hours Billed Previously

T.O. Dollars Accrued This Period *

T.O. Hours Billed This Period

T.O. Dollars Accrued to Date *

T.O. Hours Billed to Date

TO Withholding Billed to Date

TO Billed to Date with Fixed Fee (less Withholding to date)

1 Program Support and Lessons Learned $ - 0.00 -$ - -$ - -$ -$

2 On-Site Monitoring and Reporting $ - 0.00 -$ - -$ - -$ -$

3 Baseline Oversight $ - 0.00 -$ - -$ - -$ -$

4 Optional Oversight $ - 0.00 -$ - -$ - -$ -$

5 Travel and Other Direct Costs $ - -$ -$ -$

$ - 0.00 $ - 0.00 $ - - $ - $ - Project Total

Withholding of Fixed FeeCLIN Summary with Fixed Fee

COST AND HOURS BREAKDOWN BY CLIN

CLIN Summary with Fixed Fee Withholding of Fixed Fee

Combined Total

Combined Projects

* includes fixed fee regardless of deliverable acceptance and does not include associated withholding of fixed fee.

Not-to-Exceed (Allotted to Fee) Billed Previously Billed This

Period Billed to Date Balance Remaining

Billed To Date (%)

Level of Effort Fee -$ $0.00 -$ -$ -$

Withholding of Fixed Fee -$ $0.00 -$ -$ -$

Fee Less Withholding -$ $0.00 -$ -$ -$ 0.00%

Current Invoice: 1

Invoice Number Description LOE Billed (Hours)

LOE for Fixed Fee Billed (Prime

& Subs)

Consultant Hours (Reconciling Fee

Hours)

Change in (Billed)/Unbilled

Fixed Fee (excludes fixed fee withhold)

Billed Fixed Fee Withholding of Fixed Fee

Fee Withholding Adjustment

Unbilled Hours by Prime Net Invoice Total

1 0.00 0.00 0.00 -$ -$ -$ -$ 0.00 -$

Total 0.00 0.00 0.00 -$ -$ -$ -$ 0.00 -$

Fee Summary

Award CLIN Labor Hours CPFF T.O. Hours

Billed to Date T.O. Dollars

Accrued to Date * Labor Hours CPFF Labor Hours CPFF

B TOTAL 1 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B TOTAL 2 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B TOTAL 3 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B TOTAL 4 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B TOTAL 5 0 -$ 0.00 -$ 0.00 -$ 0% 0%

TOTAL ALL CLINS 0 -$ 0.00 -$ 0.00 -$ 0% 0%

Award CLIN Labor Hours CPFF T.O. Hours

Billed to Date T.O. Dollars

Accrued to Date * Labor Hours CPFF Labor Hours CPFF

H.2 TOTAL 1 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 TOTAL 2 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 TOTAL 3 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 TOTAL 4 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 TOTAL 5 0 -$ 0.00 -$ 0.00 -$ 0% 0%

TOTAL ALL CLINS 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B Table Appropriation - Consumption of Funds

H.2 Table Obligations - Consumption of Funds Task Order Authorized Accrued to Date H.2 REMAINING % Billed to Date

Task Order NTE Accrued to Date B REMAINING % Billed to Date

Project CLIN Task Name OP Responsibility Task Start Date Task End Date Due Date Report Submittal Date Days Since Submitted Approval Date FTA approver Status Notes 01/31/00 0

Enter Yellow Highlighted columns first Green columns are populated automaticallyOrange columns are dropdown selections

Standard Form 1034 Revised October 1987 Department of the Treasury

1 TFM 4-2000

1034-119-01

SCHEDULE NO.:

Federal Transit PAID BY:

Accounting Division TBP-50 0 1200 New Jersey Ave, SE Washington, DC, 20590

0 DATE INVOICE RECEIVED:

0 DISCOUNT TERMS:

PAYEE ACCOUNT NUMBER:

SHIPPED FROM GOVERNMENT B/L NUMBER

AMOUNT

PER

(1)

Task Order Number

Invoice Date: Region:

1/0/1900 0 Title Date

Payment: APPROVED FOR EXCHANGE RATE =$ =$1.00 Differences

BY

TITLE (Signature or initials)

Pursuant to authority vested in me, I certify that this voucher is correct and proper for payment.

(Date) (Authorizing Certifying Officer)3 (Title)

CHECK NO. CHECK NUMBER

DATE PAYEE3

1. When stated in foreign currency, insert name of currency. PER

TITLE

Previous edition usable

The information requested on this form is required under the provisions of 31 U.S.C. 82b and 82c, for the purpose of disbursing Federal money. The information requested is to identify the particular creditor and the amounts to be paid. Failure to furnish this information will hinder discharge of the payment obligation.

NSN 7540-00-900-2234

PRIVACY ACT STATEMENT

Type Name & Signature of Official (Payee must NOT use the space below)

TOTAL $ -

AMOUNT VERIFIED CORRECT PER

ACCOUNTING CLASSIFICATION

Pa id

B y

ON ACCOUNT OF US TREASURY ON (NAME OF BANK)

CASH

2. If the ability to certify and authority to approve are combined in one person, one signature only is necessary. Otherwise, the approving officer will sign in the space provided over his actual title.

(Use continuation sheet(s) if necessary)

3. When a voucher is received in the name of a company or corporation, the name of the person writing the company or corporate name, as well as the capacity in which he signs, must appear. For example: "John Doe Company, per John Smith, "Secretary," or "Treasurer," as the case may be.

COST

Task Order Description COST REIMBURSABLE-PROVISIONAL PAYMENT-INTERIM VOUCHER (OR COMPLETION VOUCHER, OR FINAL VOUCHER) AS APPLICABLE “I certify that all payments requested are for appropriate purposes and in accordance with the agreements set forth in the contract.”

01/00/1900 - 01/00/1900

For details see attached pages

NUMBER AND

DATE OF ORDER

VOUCHER NO.

PUBLIC VOUCHER FOR PURCHASES AND

SERVICES OTHER THAN PERSONAL

TO WEIGHT

REQUISTION NUMBER AND DATE

PAYEE:

(4)

PAYEE PAYMENT INFORMATION:

PAYEE CONTACT NAME:

U.S. DEPARTMENT, BUREAU, OR

ESTABLISHMENT AND LOCATION DATE VOUCHER PREPARED

1/0/1900

CONTRACT NUMBER AND DATE

01/00/1900 - 01/00/1900

DATE OF

DELIVERY

OR SERVICE

ARTICLES OR SERVICES

(Enter description, item number of contract or Federal supply schedule, and other information deemed necessary) QUANTITY

UNIT PRICE

PAYEE ADDRESS:

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Final

Expenditure Category Current Contract Budget

Amount Claimed Previously

Amount Claimed This Period Cumulative Total

Direct Labor -$ -$ -$ -$ Premium Pay -$ -$ -$ -$ Fringe Benefits -$ -$ -$ -$ Materials/Supplies -$ -$ -$ -$ Staff Travel -$ -$ -$ Consultant Travel -$ -$ -$ -$ Consultant Fees -$ -$ -$ -$ Subcontract -$ -$ -$ -$ Equipment -$ -$ -$ -$ Other Direct -$ -$ -$ -$ Overhead -$ -$ -$ -$ Total Est. Cost -$ -$ -$ -$ G&A -$ -$ -$ -$ Total Costs -$ -$ -$ -$ Fee -$ -$ -$ -$ Fee Withholding -$ -$

FCCM -$ -$ -$ -$

Total -$ -$ -$ -$

(Typed Name of Certifying Official) (Signature)

(Title) (Date)

SUMMARY OF EXPENDITURES

SUPPORT OF REIMBURSEMENT CLAIM

The Undersigned certifies that the cost of services reimbursable to the Contractor and the amount of fees earned by the Contractor

Cost Elements

1) Direct Labor

Labor Category Staff Assigned Hours Billed Rate Total Cumulative Category Hours Billed

Total - -$

2) Consultants' Fee -$

3) General and Administrative (G&A) Expense Total G&A Expense -$ Prime - G&A XXX.XX% of Total Direct Costs = -$ Sub - G&A XXX.XX% of Total Direct Costs = -$ Sub - G&A XXX.XX% of Total Direct Costs = -$ Sub - G&A XXX.XX% of Total Direct Costs = -$

4) Overhead Expense Total Overhead Expense -$ Prime - Overhead XXX.XX% of Total Direct Costs = -$ Sub - Overhead XXX.XX% of Total Direct Costs = -$ Sub - Overhead XXX.XX% of Total Direct Costs = -$ Sub - Overhead XXX.XX% of Total Direct Costs = -$

5) Fringe Expense Total Fringe Expense -$ Prime - Fringe XXX.XX% of Total Direct Costs = -$ Sub - Fringe XXX.XX% of Total Direct Costs = -$ Sub - Fringe XXX.XX% of Total Direct Costs = -$ Sub - Fringe XXX.XX% of Total Direct Costs = -$

6) FCCM Expense -$

7) Fixed Fee (8.5%) #N/A Fixed Fee Withholding #N/A

Fixed-Fee Calculations:

i. Total contract fixed-fee -$

ii. 85% allowable fee -$

iii. Total Cumulative fee billed on prior invoices -$

Total Fee Less Withholding #N/A

#N/A

Authorized Signature Name (Please Print)

Email Number/Extension

“I hereby certify that the above Declaration of Completion is correct and just, that payment therefore has not been received, and that the information is presented with the knowledge that the amount requested is passable to invoice the United States Government for payment."

Subtotal (before FCCM)

Total DOC Claim Amount

Contractor’s Declaration of Completion

This notice is given in support of the request to invoice for the *Direct Productive Labor Hours (DPLH) for work completed under Task Order . The voucher represents reimbursable costs for the billing period from through . Direct Labor consists of salaries and wages paid (or Billed Previously) for direct performance of the contract itemized as follows:

Direct Labor consists of salaries and wages paid (or Billed Previously) for direct performance of the contract itemized as follows: Labor Hours | Rate | Total Dollars | Cumulative Category Hours Billed.

SUPPORTING INFORMATION:

iv. Fee due this invoice (not to exceed 85% of fee earned )