J-0200000-04 Invoice Form.pdf
PDF 132 KB Posted
- Attached to
- Refinishing of Gymnasium Floors
- Solicitation number
- N4008526R0012
About this file
This is an invoice form (NAVFAC 7300/30) used by contractors to submit invoices for work performed under Naval Facilities Engineering Systems Command (NAVFAC) contracts and task orders.
The form consists of three primary sections. The Contractor's Invoice section requires the contractor to provide identifying information including DUNS number, CAGE code, invoice date and number, point of contact details, and contract number (N40085-series). The contractor must document the total contract/task order value through the current change, percentage of performance complete, value of completed performance, prior payments, and the current invoice amount. The First Endorsement section is completed by the receiving NAVFAC office and includes Receipt and Acceptance Certification, requiring documentation of work completed through a specified date, any retention or deductions, subtotal amount, previous payments, certified payment amount, elapsed contract time, responsible UIC, and various receipt and acceptance dates. The Prompt Payment Certification section requires an authorized representative to certify that accounting data is accurate, funds are properly obligated, available funds have been decremented, and changes have been applied to appropriate accounting classification reference numbers (ACRNs). The form concludes with a requirement to identify all lines of accounting to be charged, including appropriate line item numbers such as CLINs, SLINs, or ACRNs.
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Text version
ATTACHMENT J-0200000-04
INVOICE FORM
NAVFAC 7300/30 NAVAL FACILITIES ENGINEERING SYSTEMS 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 From: _________________________________________________________________ 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 (if applicable) ____________________ 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 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)
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