C04d Attachment 4 ARS_372_REQUEST FOR PAYMENT TRANSMITTAL 1232SA26Q1276.pdf
PDF 30 KB Posted
- Attached to
- Fence Installation for USDA ARS in Parlier, CA (Amended) Federal contract opportunity
- Solicitation number
- 1232SA26Q1276
About this file
This is a Contractor's Request for Payment Transmittal form (ARS-372) used by contractors to request progress or final payments on USDA-ARS contracts. The form documents the financial status of contract performance, including the original contract amount, any change orders or amendments, the total adjusted contract price, and the value of work completed through the reporting period. Contractors must also itemize any materials stored at the site and calculate the cumulative amount due, accounting for retainage percentages and previously received payments to arrive at the net payment amount due.
The form includes a mandatory Contractor's Progress Payment Certification in which the authorized contractor representative certifies that all requested amounts correspond to contract-compliant performance, that all subcontractor and supplier payments from previous invoices have been made in accordance with Chapter 39 of Title 31, United States Code, that no amounts are being wrongfully withheld from subcontractors, and that the certification does not constitute final acceptance of subcontractor work. The form requires signatures and dates from the contractor's authorized representative, the Engineer/Project Manager (EPM), Contracting Officer's Representative (COR), Construction Manager (CM), or A-E, as appropriate, along with a concurring signature from the EPM or COR.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| C05 SF30 1232SA26Q1276.pdf | ||
| C05a Attachment 6 Questions and Answers.pdf | ||
| C04 SF1442 RFQ Solicitation 1232SA26Q1276.pdf | ||
| C04c Attachment 3 ARS_371_CONSTRUCTION PROGRESS 1232SA26Q1276.pdf | ||
| C04a Attachment 1 Statement of Work.pdf | ||
| C04b Attachment 2 Wage Determination 1232SA26Q1276.pdf | ||
| C04e Attachment 5 SF1413 Subcontractor Acknowlegement 1232SA26Q1276.pdf |
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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.: |
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