J-0200000-04 Invoice Form.docx

ATTACHMENT J-0200000-04

INVOICE FORM

NAVFAC 7300/30 NAVAL FACILITIES ENGINEERING COMMAND

(Rev 2/01

DUNS NO: ______________

1. CONTRACTOR’S INVOICE CAGE CODE NO: ______________

From: ____________________________________ Invoice Date: ______________ ____________________________________ Invoice Number: ______________ POC/Telephone/email for this invoice: __________________________________________________________ To: Contract Specialist: _____________________________________________________________________ Below is a Statement of Performance under Contract N40085-_______________Task Order: ______________ For _____________________________ at _____________________________________________________

The enclosure provides breakdown of this statement of performance.

A. Total value of contract/task order through change _________ ________________ B. Percentage of performance complete _________ ________________ C. Value of completed performance _______________ D. Less total of prior payments _______________ E. Amount of this invoice _______________ Signature and Title: ______________________________________________ Date: Signature of Authorized Representative

2. FIRST ENDORSEMENT Receipt and Acceptance Certification

1. Payment is recommended as follows:

A. Amount of work completed to (date) ______________ ___________________ B. Less:

L. I certify this amount is correct and payment i8s recommended.

Signature: ________________________________________ Date: _________________________ Signature of Authorized Representative Name and Title (Typed): ______________________________________________________ Phone and address: ______________________________________________________

3. PROMPT PAYMENT CERTIFICATION

I certify that the accounting data provided is accurate, funds have been obligated in appropriate accounting system and changes have been applied to the appropriate accounting classification reference number (ACRN), available funds have been decremented for the amount approved for disbursement and will not be de-obligated and the above invoice is correct and proper for payment.

Signature: _____________________________ Date: __________________ Signature of Authorized Representative Name and Title (typed): ______________________________________________________ Phone and address: _________________________________________________________ Line(s) of accounting to be used for this invoice (include appropriate Line Item # (CLIN, SLIN, OR ACRN, etc)