FORM ARS 372 CONTRACTOR REQUEST FOR PAYMENT TRANSMITTAL.pdf
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- Solicitation number
- 12905B20R0024
About this file
This document contains a federal contract solicitation and a contractor payment request form. The solicitation seeks a contractor to upgrade the HVAC system at Building 2 and upgrade the entrances and vestibules at Building 1 of the Northwest Irrigation & Soils Research Lab in Kimberly, Idaho. The base requirement is for HVAC replacements at Building 2, with an option to also upgrade the entrances and vestibules at Building 1 if additional funds are available. The completion period is 240 calendar days from notice to proceed. A site visit is scheduled for July 14, 2020. The contractor must have an OSHA-certified competent person on site whenever work is being performed. Interested parties should register at beta.sam.gov and address all questions in writing to the issuing office. The payment request form is for a contractor to request payment from the government under an existing contract and includes fields for original contract amount, change orders, amounts paid to date, retainage, and certifications of prior payments to subcontractors.
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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 % retainage
MATERIAL STORED AT THE SITE (See Item 5 above)
Description Value
CONTRACTOR'S CERTIFICATION OF PAYMENT
By signing this request for payment, I certify that I have made payment from the proceeds of prior payments, and that I will make timely payment from the proceeds of this payment, of amounts due my subcontractors and suppliers in accordance with my con-tractual arrangements with them.
SIGNATURE OF CONTRACTOR'S AUTHORIZED REPRESENTATIVE
RECOMMENDED FOR PAYMENT (Signature of EPM, COR, CM or A.E. as ppropriate)
CONCUR (Signature of EPM or COR as appropriate)
DATE SIGNED
DATE SIGNED
DATE SIGNED
Form ARS-372 (11/84) Replaces SEA-372 (1/79) which may be used. USDA-ARS This form was electronically produced by USDA/ARS/ITD using InForms software.
File details come from the government source that posted it. Updated .