J-0200000-04 Invoice Form.pdf
PDF 182 KB Posted
- Attached to
- Landfill Maintenance and Repair Services
- Solicitation number
- N4008525R2529
About this file
This is NAVFAC Form 7300/30, a contractor's invoice template used by the Naval Facilities Engineering Command (NAVFAC) for billing and payment processing. The form consists of three main sections: (1) Contractor's Invoice section where contractors input their company information, contract/task order details, and invoice amounts including total contract value, percentage complete, and payment requested; (2) First Endorsement section for government receipt and acceptance certification, which includes fields for tracking retention, deductions, payment certification, and key dates like material/services receipt and acceptance; and (3) Prompt Payment Certification section where government officials certify funding availability and accounting data accuracy.
The form requires multiple authorization signatures and includes fields for critical tracking information such as DUNS number, CAGE code, contract number (specifically referencing N40085), task order numbers, and accounting line items (CLIN, SLIN, or ACRN). This template appears to be revision 2/01 and is designated as Attachment J 0200000 04.
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Text version
NAVAL FACILITIES ENGINEERING COMMAND
DUNS NO:
NAVFAC 7300/30
(Rev 2101)
1. CONTRACTOR'S INVOICE
From:
CAGE CODE NO:
Invoice Date Invoice Number __
POC/Telephonelemail for this invo_..:ic:::e
To: Contract Specialist:
Below is a Statement of Performance under Contract N40085- Task Order:
"'-'-'-'"--'-'-'-'-------------'-""-"...C..C-'--"-'---for at
The enclosure provides breakdown of this statement of performance.
A. Total value of contracUtask 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 Representalive
2. FIRST ENDORSEMENT
From:
Receipt and Acceptance Certification
To:
1. Payment is recommended as follows:
A. Amount of work completed to (date) B. Less:
Retention Other Deductions:
C. Subtotal D. Less previous payments E. Certified amount for payment # Final on TO# F. Elapsed contract time <"''"''""'!
G. Responsible Certifying UIC H. Invoice Receipt Date I. Material/Services Receipt Date
J. Material/Services Acceptance Date K. Date forwarded to paying office L. I certify this amount is correct and payment is recommended.
Signature: _________________ _ Signature of Authorized Represenlative
Date:
Name and Title (typed): _______________________ _ Phone and address:
3. PROMPT PAYMENT CERTIFICATION
l certlty that the accounbng !lata pro via ea 1s accurate, tunds have oeen 0011gated m appropnate accoubng system and Cl'langes have been applied to tne app,rpnate accoonbng dass1fica�on reference number (ACRN}, ava1lab!e funds have been decremented for the amount approved for disbursement and WIii not oe de-obligated and the aboave invoice is correct and p(Oper for pay men!
Signature: _________________ _ Signature of Authorized Representative
Name and Title (typed):
Date:
Phone and address:--------------------------une(s) of accounting to be used for this invoice {include appropriate Line Item# (CUN, SUN, or ACRN, etc)
ATTACHMENT J 0200000 04
File details come from the government source that posted it. Updated .