J-3_Stage_Completion_Certificate_Template.pdf
PDF 103 KB Posted
- Attached to
- NPS ISRO Ranger IV Vessel
- Solicitation number
- 140PS125R0009
About this file
The document is a Ranger IV Stage Completion Certificate template, designed for documenting contract milestone completion and payment requests. The form provides spaces for critical contract details including contract number, contractor information, CLIN (Contract Line Item Number) details, percentage of work completed, starting and current balances, and a description of work performed. The template requires signatures from an authorized contractor representative and a government representative who has inspected the completed stage of work, serving as an official certification that contract requirements have been met.
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Text version
RANGER IV STAGE COMPLETION CERTIFICATE
Contract Number Payment Request Number
Contractor
Period of time covered by completion certificate
CLIN Number
Percentage Requesting Cumulative Percentage
CLIN Starting Balance CLIN Current Balance
Payment Milestone Name:
Description of Work Performed: (A brief description of the Milestone or portion of task completed and how completion was determined, inspected and measured)
Government Representative who inspected the completed stage of work
I hereby certify that the work was performed and complies with the contract requirements.
Authorized Contractor Representative Name
Authorized Contractor Representative Title
Signature
Date
| Contract Number: |
| Payment Request Number: |
| Contractor Name: |
| Period of Payment Request: |
| CLIN Number: |
| Percentage Requesting: |
| Cummulativce Percentage: |
| CLIN Starting Balance: |
| CLIN Current Balance: |
| Payment Milestone Name: |
| Description of Work: |
| Authorized Contractor Name: |
| Authorized Title: |
| Date: |
| Government Name: |
File details come from the government source that posted it. Updated .