JA-9_AF_Form_3065 _Contract_Progress_Report.pdf

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AF IMT 3065, 19960401, V1 PREVIOUS EDITION IS OBSOLETE.

FA5004-15-R-C006

JA-9