B08 Invoice Payment Request.docx
DOCX document 33 KB Posted
- Attached to
- Construct New Well, Mojave National Preserve Federal contract opportunity
- Solicitation number
- 140P8121R0006
About this file
This document contains an invoice payment request form and details of a related federal contract opportunity to construct a new well at Mojave National Preserve. The invoice form requests payment for work completed under Contract Number 140P8121R0006 issued by the National Park Service Pacific West Region. It includes lines to capture the contractor name and address, description and location of work performed, accounting and appropriation data, quantities and prices for bid items, amounts invoiced and paid to date including any retained percentages, and certifications required for progress payments. The related federal contract opportunity solicitation is to construct a new well at Mojave National Preserve, with responses due under Solicitation Number 140P8121R0006. No further details are provided on response dates, award dates, pricing terms, set asides or incumbent.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140P8121R0006_Amd_0004.pdf | ||
| B09_Questions_and_Answers_amend_04_0004.pdf | ||
| Sol_140P8121R0006_Amd_0003.pdf | ||
| B09_Questions_and_Answers_0003.pdf | ||
| Sol_140P8121R0006_Amd_0002.pdf | ||
| Sol_140P8121R0006_Amd_0001.pdf | ||
| B08 MOJA Map.pdf | ||
| A06 8K1 Well Completion Report.pdf | ||
| A04 Specifications.pdf | ||
| B08 Release of Claims.pdf | ||
| B08 Contract Price Schedule.pdf | ||
| B03 General Decision.pdf | ||
| Sol_140P8121R0006.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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