Atch__10_-_BLANK_SAMPLE_AF_Form__3065.pdf

PDF 32 KB Posted

Attached to
Civil Engineering Multiple Award Construction Contract (CEMACC) Federal contract opportunity
Solicitation number
FA8501-17-R-0001
Issued by
Department of the Air Force Materiel Command Lifecycle Management Center Robins Air Force Base

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Blank Sample AF For 3065

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COMPLETIO

N DATE

FROM: TO:

LINE NO. % OF TOTAL JOB

% COMPLETED

THIS PERIOD

% COMPLETED

CUMULATIVE

1 0.00% 0.00% 0.00%

2 0.00% 0.00% 0.00%

3 0.00% 0.00% 0.00%

4 0.00% 0.00% 0.00%

5 0.00% 0.00% 0.00%

6 0.00% 0.00% 0.00%

7 0.00% 0.00% 0.00%

8 0.00% 0.00% 0.00%

9 0.00% 0.00% 0.00%

10 0.00% 0.00% 0.00%

11 0.00% 0.00% 0.00%

12 0.00% 0.00% 0.00%

13 0.00% 0.00% 0.00%

14 0.00% 0.00% 0.00%

15 0.00% 0.00% 0.00%

16 0.00% 0.00% 0.00%

17 0.00% 0.00% 0.00%

18 0.00% 0.00% 0.00%

19 0.00% 0.00% 0.00%

20 0.00% 0.00% 0.00%

21 0.00% 0.00% 0.00%

22 0.00% 0.00% 0.00%

23 0.00% 0.00% 0.00%

24 0.00% 0.00% 0.00%

25 0.00% 0.00% 0.00%

26 0.00% 0.00% 0.00%

27 0.00% 0.00% 0.00%

28 0.00% 0.00% 0.00%

29 0.00% 0.00% 0.00%

30 0.00% 0.00% 0.00%

31 0.00% 0.00% 0.00%

32 0.00% 0.00% 0.00%

33 0.00% 0.00% 0.00%

34 0.00% 0.00% 0.00%

35 0.00% 0.00% 0.00%

WORK ELEMENT

CONTRACTOR ADDRESS

CONTRACT NO.

REPORT

NO.

PERIOD COVERED PROJECT NO.

XXXXXX

CONTRACT PROGRESS REPORT

OMB NO. 0704-0188

FA8501-XX-X-XXXX

LINE NO. % OF TOTAL JOB

% COMPLETED

THIS PERIOD

% COMPLETED

CUMULATIVE

WORK ELEMENT

36 0.00% 0.00% 0.00%

37 0.00% 0.00% 0.00%

38 0.00% 0.00% 0.00%

39 0.00% 0.00% 0.00%

40 0.00% 0.00% 0.00%

41 0.00% 0.00% 0.00%

42 0.00% 0.00% 0.00%

43 0.00% 0.00% 0.00%

44 0.00% 0.00% 0.00%

TOTAL 0% 0% 0%

REMARKS

Date

At the Contracting 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 specs.

SUBMITTED BY OR FOR

TYPED NAME AND TITLE

TYPED NAME AND TITLE

Project Manager

REVIEWED BY OR FOR CONTRACTING OFFICER

DATE

Construction Inspector: Print Name ______________________ Signature:

SIGNATURE

SIGNATURE DATE

CONTRACTOR 78th CIVIL ENGINEERS

AF Form 3065

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