JA-9_AF_Form_3065.pdf

PDF 35 KB Posted

Attached to
Airfield Striping Federal contract opportunity
Solicitation number
FA5004-14-B-C005
Issued by
Department of the Air Force Pacific Air Forces

About this file

From the source

AF Form 3065 Progress Report

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OMB NO. 0704-0188CONTRACT PROGRESS REPORT

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (OMB No. 9000-0058), 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. RETURN COMPLETED FORM TO : SAF/AQCO, 1060 Air Force Pentagon, Washington DC 20330-1060.

CONTRACTOR ADDRESS

REPORT NO. PERIOD COVERED

FROM:

PROJECT NO. CONTRACT NO. COMPLETION DATE

TO:

LINE

NO.

% OF

TOTAL JOB

% COMPLETED

THIS PERIOD

% COMPLETED

CUMULATIVE

WORK ELEMENT

TOTAL

REMARKS

At the Contracting Officer's discretion and according to the payments clause of the contract, the information provided on this form may be used for computing progress payments.

PROGRESS OR COMPLETION CERTIFICATE

I hereby certify that the contractor has satisfactorily completed the indicated percentage of the contract per contract specifications.

SUBMITTED BY OR FOR

CONTRACTOR BASE CIVIL ENGINEER

TYPE OR PRINT NAME AND TITLE SIGNATURE DATE

REVIEWED BY OR FOR CONTRACTING OFFICER

TYPE OR PRINT NAME AND TITLE SIGNATURE DATE

AF IMT 3065, 19960401, V1 PREVIOUS EDITION IS OBSOLETE.

OMB NO 07040188:
CONTRACTOR:
ADDRESS:
REPORT NO:
PERIOD COVERED FROM TO:
PROJECT NO:
CONTRACT NO:
COMPLETION DATE:
LINE NORow1:
WORK ELEMENTRow1:
OF TOTAL JOBRow1:
COMPLETED THIS PERIODRow1:
COMPLETED CUMULATIVERow1:
LINE NORow2:
WORK ELEMENTRow2:
OF TOTAL JOBRow2:
COMPLETED THIS PERIODRow2:
COMPLETED CUMULATIVERow2:
LINE NORow3:
WORK ELEMENTRow3:
OF TOTAL JOBRow3:
COMPLETED THIS PERIODRow3:
COMPLETED CUMULATIVERow3:
LINE NORow4:
WORK ELEMENTRow4:
OF TOTAL JOBRow4:
COMPLETED THIS PERIODRow4:
COMPLETED CUMULATIVERow4:
LINE NORow5:
WORK ELEMENTRow5:
OF TOTAL JOBRow5:
COMPLETED THIS PERIODRow5:
COMPLETED CUMULATIVERow5:
LINE NORow6:
WORK ELEMENTRow6:
OF TOTAL JOBRow6:
COMPLETED THIS PERIODRow6:
COMPLETED CUMULATIVERow6:
LINE NORow7:
WORK ELEMENTRow7:
OF TOTAL JOBRow7:
COMPLETED THIS PERIODRow7:
COMPLETED CUMULATIVERow7:
LINE NORow8:
WORK ELEMENTRow8:
OF TOTAL JOBRow8:
COMPLETED THIS PERIODRow8:
COMPLETED CUMULATIVERow8:
LINE NORow9:
WORK ELEMENTRow9:
OF TOTAL JOBRow9:
COMPLETED THIS PERIODRow9:
COMPLETED CUMULATIVERow9:
LINE NORow10:
WORK ELEMENTRow10:
OF TOTAL JOBRow10:
COMPLETED THIS PERIODRow10:
COMPLETED CUMULATIVERow10:
LINE NORow11:
WORK ELEMENTRow11:
OF TOTAL JOBRow11:
COMPLETED THIS PERIODRow11:
COMPLETED CUMULATIVERow11:
LINE NORow12:
WORK ELEMENTRow12:
OF TOTAL JOBRow12:
COMPLETED THIS PERIODRow12:
COMPLETED CUMULATIVERow12:
LINE NORow13:
WORK ELEMENTRow13:
OF TOTAL JOBRow13:
COMPLETED THIS PERIODRow13:
COMPLETED CUMULATIVERow13:
LINE NORow14:
WORK ELEMENTRow14:
OF TOTAL JOBRow14:
COMPLETED THIS PERIODRow14:
COMPLETED CUMULATIVERow14:
LINE NORow15:
WORK ELEMENTRow15:
OF TOTAL JOBRow15:
COMPLETED THIS PERIODRow15:
COMPLETED CUMULATIVERow15:
OF TOTAL JOBTOTAL:
COMPLETED THIS PERIODTOTAL:
COMPLETED CUMULATIVETOTAL:
REMARKS:
undefined:
BASE CIVIL ENGINEER: Off
TYPE OR PRINT NAME AND TITLE:
SIGNATURE:
DATE:
TYPE OR PRINT NAME AND TITLE_2:
SIGNATURE_2:
DATE_2:

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