B08_Invoice_Payment_Request.docx
DOCX document 33 KB Posted
- Attached to
- Replace Courtesy Dock, Lake Mead, Nevada Federal contract opportunity
- Solicitation number
- 140P8122R0005
About this file
This invoice payment request form is for a construction contract to replace a courtesy dock at Hemenway Harbor Lake Mead National Recreation Area. The contractor provides their name and address and a description of work completed to date. Dollar amounts are included for the total contract, amounts completed and paid to date, retainage held, and the amount due for the current invoice. As part of the progress payment process, the contractor certifies that payments to subcontractors have been made in accordance with contract terms and applicable law. Additional pages provide subcontractor payment information including the subcontract amounts, amounts performed and previously paid for each subcontract.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B03_General_Decision_AZ20220006.pdf | ||
| B03_General_Decision_NV20220024.pdf | ||
| B08_Transmittal.pdf | ||
| B08_Contract_Price_Schedule.pdf | ||
| B08_Release_of_Claims.pdf | ||
| A04_Project_Specifications.pdf | ||
| Sol_140P8122R0005.pdf |
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Text version
INVOICE/Payment Request
Date Prepared:
| Sheet | of |
| INVOICE/Payment Number: |
| Contract Number: | |
| Required Completion Date: | |
| Prompt Payment Discount: | |
| % if paid in | days after |
Contractor’s Name and Address:
Description and Location of Work:
Accounting and Appropriation Data:
Bid Item
| Description from Bid Price Schedule |
| Total Contract Amounts |
| Actual Amount Complete To-Date |
| UNIT |
| QTY |
| UNIT PRICE |
| AMOUNT |
| QTY |
| AMOUNT |
Total:
Total:
| REMARKS: (“Contractor’s Release” statement MUST be |
| a. Previous deductions other than retained percentage |
completed before FINAL PAYMENT under this contract will be made.) Attach Subcontract Payment Data for Progress
b. Previous retained percentage
| Payments as required by Payments Clause, FAR 52.232-5. |
| c. Previous payments |
d. Previous earnings (a + b + c)
e. Earnings this period (Total “To-date” – d)
f. Less retained percentage
g. Less deduction other than retained percentage
h. Total deductions this period (f + g)
| NPS Actions: |
| i. Amount due contractor this period (e + h) |
| Admin Compliance Checked: |
| Date: |
| j. Plus previous retained |
k. Total amount due (i+ j)
| Received Date: |
| Accepted Date: |
| RECAPITULATION: (sum of retained, paid, & balance = total contract amount) |
TOTAL RETAINED: (a + b + h - j):
| Contracting Officer Approval: |
| Date Signed: |
| TOTAL PAID (c + k): |
BALANCE remaining after this payment:
| COR Approval: |
| Date Signed: |
| Page 1 of 2 |
| COMPLETE IF PROGRESS PAYMENTS ARE MADE UNDER THE CONTRACT: |
In accordance with the clause at FAR 52.232-5, Payments Under Fixed Price Construction Contracts, I hereby certify to the best of my knowledge and belief that:
(1) The amounts requested are only for performance in accordance with the specifications, terms and conditions of the contract;
(2) Payments to subcontractors and suppliers have been made from the previous payments received under the contract, 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; and
(3) This request for Progress Payments does not include any amounts that the Prime Contractor intends to withhold or retain from a subcontractor or supplier in accordance with the terms and conditions of the contract.
(4) This certification is not to be construed as final acceptance of a subcontractor’s performance. (If applicable)
| NAME: | TITLE: | |
| (Print/Type Name) | (Print/Type Title) | |
| SIGNATURE: | DATE: |
Subcontractor Payment Information
| Date Prepared: | |
| Sheet | of |
| INVOICE/Payment Number: |
| Contract Number: |
| Required Completion Date: |
| Name of Subcontractor: |
| Subcontractor Address: |
Amount of Subcontract:
Amount Performed This Request:
Total Amount Previously Paid:
| Name of Subcontractor: |
| Subcontractor Address: |
Amount of Subcontract:
Amount Performed This Request:
Total Amount Previously Paid:
| Name of Subcontractor: |
| Subcontractor Address: |
Amount of Subcontract:
Amount Performed This Request:
Total Amount Previously Paid:
| Name of Subcontractor: |
| Subcontractor Address: |
Amount of Subcontract:
Amount Performed This Request:
Total Amount Previously Paid:
| Name of Subcontractor: |
| Subcontractor Address: |
Amount of Subcontract:
Amount Performed This Request:
Total Amount Previously Paid:
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