J-0200000-04 Invoice Form Sample.xls
XLS spreadsheet 73 KB Posted
- Solicitation number
- N62470-22-R-0006
About this file
This document contains an invoice form sample and related federal contract opportunity solicitation. The invoice form sample provides a template for contractors to submit invoices under a federal contract, including sections for contractor identification information, contract details, performance completion percentages, prior payments, and payment certification.
The related federal contract opportunity solicitation is for base operations support services at the Russell Knox Building, a secure facility aboard Marine Corps Base Quantico in Virginia. Services include facilities management, maintenance, utilities, custodial services, waste management, pest control, and other support functions. The solicitation notice indicates interested offerors should review the full solicitation and attachments for additional requirement details. The soliciting agency is the Department of the Navy Naval Facilities Engineering Command.
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Text version
7300-30
| ATTACHMENT J-0200000-04 | ||||||
| INVOICE FORM SAMPLE | ||||||
| 1. CONTRACTOR'S INVOICE | CAGE Code | |||||
| From | Invoice Date | |||||
| Invoice Number | ||||||
| DUNS No. | ||||||
| Contractor's remittance address | ||||||
| (if different than mailing address, contract requires Modification) | ||||||
| Contractor POC/Telephone/email for this invoice: | ||||||
| Below is a Statement of Performance under Contract# | ||||||
| for | ||||||
| The enclosure provides breakdown of this statement of performance. | ||||||
| A. | Total value of contract/task order through modification | |||||
| B. | Percentage of performance complete | |||||
| C. | Value of completed performance | |||||
| D. | Less total of prior payments | |||||
| E. | Amount of this invoice | |||||
| Signature and Title: | President | |||||
| Date: | Signature of Authorized Representative | |||||
| Taxpayer Identification No. (TIN): _______________________ | ||||||
| Electronic funds transfer (EFT) banking information (if applicable): | ||||||
| (EFA use only) | ||||||
| Fund Usage # | _____________ |
7300-31
| ATTACHMENT J-0200000-04 | |||||||||
| INVOICE FORM SAMPLE | |||||||||
| CONTRACT | |||||||||
| Sheet __________ of __________ | |||||||||
| Period Ending | |||||||||
| LOCATION: | |||||||||
| TO BE COMPLETED BY CONTRACTOR | ROICC USE ONLY | ||||||||
| Cost Category | CLIN #, SLIN #, or ACRN # | Description | Estimated Cost | % Complete | Value | % | Construction in Place | ||
| Value | Prior Report | This Period | |||||||
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | |
| Totals | $0.00 | 0.00% | $0.00 | ||||||
| Undistributed Charges-Material | |||||||||
| Other | |||||||||
| Grand Totals | |||||||||
| Remarks: | |||||||||
| Signature: | Date: | ||||||||
| Signature of Authorized Representative | |||||||||
| Name and Title (typed): | |||||||||
| Phone and address: | |||||||||
| (iaw FAR 32.905) |
Pay Cert
| ATTACHMENT J-0200000-04 |
| INVOICE FORM SAMPLE |
| PAYMENT CERTIFICATION |
| TITLE OF PROJECT WITH DELIVERY ORDER |
| CONTRACT _______________________________ , D.O. # |
| I hereby certify, to the best of my knowledge and belief, that: |
| (1) The amounts requested are only for the performance in accordance with the specifications, terms, and conditions of the contract; |
| (2) Payments to subcontractors and suppliers have been made from previous payments received under the contract and timely payments will be made from the proceeds of the payment covered by this certification, code; and |
| (3) This request for progress payment does not include any amounts which the prime contractor intends to withhold or retain from a subcontractor or supplier in accordance with the terms and conditions of the subcontract. |
| __________________________________ |
| (Name) |
| __________________________________ |
| (Title) |
| __________________________________ |
| (Date) |
Final Release
| ATTACHMENT J-0200000-04 | ||
| INVOICE FORM SAMPLE | ||
| CONTRACTOR'S RELEASE | ||
| NAVFAC 4330/7 (6-72) | ||
| S/N 0105-001-9100 | ||
| CONTRACTOR'S RELEASE UNDER CONTRACT_____________________ | ||
| KNOW ALL MEN BY THESE PRESENTS: In consideration of the premise and the sum of ___________________________ | ||
| __________________________________________($______________________________________________________) | ||
| lawful money of the United States of America(hereinafter called the "Government")__________________________________ | ||
| __________________________________________($______________________________________________________) | ||
| of which has already been paid and_______________________________________________________________________ | ||
| __________________________________________($______________________________________________________) | ||
| of which is to be paid by the Government under the above-mentioned contract, the undersigned | ||
| Contractor does, and by the receipt of said sum shall, for itself, its successors and assigns, remise, | ||
| release and forever discharge the Government, its officers, agents, and employees, of and from all | ||
| liabilities, obligations and claims whatsoever in law and in equity under or arising out of said contract. | ||
| IN WITNESS WHEREOF, this release has been executed this_______day of__________20____ | ||
| _____________________________________ | ||
| (Contractor) | ||
| WITNESS: | ||
| _____________________________ BY:_____________________________________ | ||
| _____________________________ TITLE:_____________________________________ | ||
| CERTIFICATE | ||
| I,__________________________________, certify that I am the___________________________ | ||
| secretary of the corporation named as Contractor in the foregoing release; that________________ | ||
| _________________________who signed said release on behalf of the Contractor was then | ||
| _________________________________of said corporation; that said release was duly signed | ||
| for and in behalf of said corporation by authority of its governing body and is within the scope | ||
| of its corporate powers. | ||
| (Corporate Seal) | _____________________________________ |
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