Attachment J.19 CPFMD Invoice Verification Form.pdf
PDF 72 KB Posted
- Attached to
- DC Courts Program Management Services
- Solicitation number
- Not on record
- Issued by
- District of Columbia Government
About this file
This invoice verification form is used to process payment requests for the District of Columbia Courts Program Management Services contract. The contractor must submit invoices electronically through the U.S. Department of the Treasury's Invoice Processing Platform, providing the contract and purchase order numbers, invoice and service dates, and certification signed by an authorized representative. Invoices must include timesheets, subcontractor invoices, other direct cost invoices, and travel documentation. Payments will be applied to the approved budget amounts for labor, other direct costs, indirect costs, and fee for contract number DCSC-23-RFP-0166, awarded by the District of Columbia Government to provide program management services for the District of Columbia Courts.
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Text version
Attachment J.19
J.19 CPFMD Invoice Verification Form
Payment request shall be submitted electronically through the U.S. Department of the Treasury’s Invoice Processing Platform (IPP) System using the “Bill to
Agency” of Interior Business Center-FMD. The IPP website address is https://www.ipp.gov.
Invoice Number: _________
Name and address of the Contractor:__________________________________
Contract Number :________________________________________________
Purchase Order Number:_____________________________________________
Invoice date:______________________________________________________
Date the services were rendered:_____________________________________
Name, title, phone number, and mailing address of person to be notified in the event of a defective invoice, Name of the Contracting Officer Technical Representative (COTR):_______________
COTR email address: ____________________________________________________
(1) The invoice shall include a certification, signed by an authorized representative of the
Contractor, as follows:
The undersigned hereby certifies to the best of my knowledge and belief that the fiscal report and any attachments have been prepared from the books and records of the Contractor in accordance with the terms of this contract and are correct: the sum claimed under this contract is proper and due, and all the costs of contract
TOTAL EXPENDITURES
(Contract Number : DCSC-23-RFP-0166
Line Item
Description
Approved
Budget
Amt.
Voucher To
Date
Amt.
Voucher
This Period
Balance of
Approved
Budget 0001 Labor (Salary +
Fringe)
$XXXX.XX $XXXX.XX
0002 Other Direct
Cost
$XXXX.XX $XXXX.XX
0003 Indirect Cost $XXXX.XX $XXXX.XX
0004 Fee $XXXX.XX $XXXX.XX
Total $XXXX.XX $XXXX.XX https://www.ipp.gov/
Attachment J.19 performance (except as herewith reported in writing) have been paid, or to the extent allowed under the applicable payment clause, will be paid currently by the
Contractor when due in the ordinary course of business; the work reflected by these costs has been performed, and the quantities and amounts involved are consistent with the requirements of this Contract; all required Contracting Officer approvals have been obtained; and appropriate refund to The Court will be made promptly upon request in the event of disallowance of costs not reimbursable under the terms of this contract.
BY: TITLE: DATE:
Attachments to Invoice:
• Timesheets
• Subcontractor Invoices
• Other Direct Cost Invoices
• Travel (plane ticket invoices, hotel invoices, other supporting documentation to justify the expense)
File details come from the government source that posted it. Updated .