Exhibit 5 Progress Payment Request.pdf
PDF 28 KB Posted
- Attached to
- JBSA Randolph T-7 Shelters Federal contract opportunity
- Solicitation number
- FA301625R6135
About this file
This document is a Progress Payment Request form designed for use in federal contract payment processing. The form is specifically associated with a contract for the JBSA Randolph T-7 Shelters project, a small business set-aside procurement under NAICS code 332311 for prefabricated metal building and component manufacturing. The form provides a structured template for contractors to request progress payments, including sections for certifying work completion, detailing contract amounts, and breaking out line items (CLINs) for invoicing. Key requirements include documenting percentage of work completed, tracking previous payments, and providing certification that payments to subcontractors have been or will be made in accordance with contract terms. The payment terms specify NET 14 for monthly payments and NET 30 for final payment, with spaces for both contractor and government official signatures and documentation.
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Text version
PHONE:
FAX:
0.00%
PROGRESS PAYMENT REQUEST
COMPLETED
BY CONTRACTOR
GOVERNMENT
USE ONLY
GOVERNMENT
USE ONLY
POC's E-Mail Address
0.00%
Less Previous Payments
PERFORMANCE PERIOD:
Amount Completed/Percentage of
Progress Completed
502D Contracting Squadron
SIGNATURE TYPE OR PRINT NAME AND TITLE
NAME / TITLE
II. Total Amount of Contract:
(including modifications)
CONTRACT / DELIVERY ORDER NUMBER: CONTRACTOR:
DESCRIPTION OF WORK
NET 14 for Monthly Payments or NET 30 for Final Payment
PAYMENT TERMS
INVOICE NO. DATE
IF YOU HAVE ANY QUESTIONS CONCERNING THIS INVOICE, PLEASE CONTACT ME AT:
DATE
CONTRACTING OFFICIAL:
Government Use Only
Authorize Progress Payment #
TYPE OR PRINT NAME AND TITLE SIGNATURE DATE
In the Total Amount of
I certify that the services have been rendered in accordance with the terms and conditions of subject contract
Total Amount Due This Progress Payment
Total Amount for CLINS:
I. 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) 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
(4) This certification is not to be construed as final acceptance of a subcontractor's performance.
Contracting Officer
III. Breakout of CLINS for Invoice:
COMPLETED BY CONTRACTOR
Subtotal (Balance)
Subtotal (Balance) -$
-$ Less Retainage on Payment Request
File details come from the government source that posted it. Updated .