J-0200000-04 Invoice Form.pdf

Attachment J-0200000-04 Invoice Form

1. CONTRACTOR'S INVOICE

From Invoice Date Invoice Number

POC/Telephone/email for this invoice:

To: Contract Specialist:

Below is a Statement of Performance under Contract 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

Taxpayer Identification No.

(TIN):

Electronic funds transfer (EFT) banking information (if applicable):

2. FIRST ENDORSEMENT

From: Accountable Official

To: Certifying Officer A. Amount of work completed to (date) $ B. Less:

Retention $

Other Deductions $ $ C. Subtotal $ D. Less previous payments $ E. Certified amount for payment # on TO # $

F. Elapsed contract time (if applicable)

Attachment J-0200000-04 Invoice Form

CONTRACT

Sheet __________ of __________

Period Ending

LOCATION:

TO BE COMPLETED BY CONTRACTOR GOVERNMENT USE ONLY

Cost Category

CLIN #,

SLIN #,

or ACRN # Description Estimated Cost

Complete Value % Work in Place

Value Prior Report This Period

(1) (2) (3) (4) (5) (6) (7) (8) (9)

Totals

Undistributed Charges-Material

Other

Grand Totals Remarks:

Signature: Date:

Signature of Authorized Representative (Contractor)

Name and Title

(typed):

Phone and address:

(iaw FAR 32.905)