S02 - VA Form 10-6001a Contract Progress Report.pdf
PDF 529 KB Posted
- Attached to
- Z2DA--537-21-113 Remodel Blood Draw
- Solicitation number
- 36C25223B0021
About this file
This document contains a contract progress report template and information on a related federal contract opportunity for remodeling a blood draw area at a Veterans Affairs medical center. The progress report form is used to track performance on construction contracts with the VA and requires details such as the project number, contract amount, completion dates, values of work completed, payments made, and notes. The related federal opportunity is a solicitation to remodel the blood draw area at the Jesse Brown VA Medical Center for project number 536-21-113 issued by the VA Veterans Health Administration VISN 12. The opportunity type is a solicitation and additional information provided includes the solicitation number and agency involvement.
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Text version
CONTRACT PROGRESS REPORT
LOCATION OF PROJECT
TO
Centra Texas Health Care System (CTVHCS) 1901 Memorial Drive Temple, TX 76504
1. PROJECT NO. 2. CONTRACT NO. 3. DATE CONTRACT AWARD 4. DATE NOTICE TO PROCEED RECEIVED
6. NAME AND ADDRESS OF CONTRACTOR 7. DESCRIPTION OF CONTRACT
12. EXTENDED CONTRACT COMPLETION DATE
ITEM
NO.
15.
VA FORM
JUN 2012 10-6001a
5. DATE CONST. STARTED
BRANCH OF WORK TOTAL VALUE VALUE OF WORK IN
PLACE-END LAST PERIOD
VALUE OF WORK INSTALLED
IN CURRENT PERIOD(A) (B)
(C) (D)
13. ESTIMATED COMPLETION DATE
OMB Approval No. 2900-0208 Estimated burden 12 minutes
16.
17.
18.
19.
20.
21.
22.
23.
14. DATE COMPLETED
8. ORIGINAL CONTRACT AMOUNT
9. SCHEDULED PERCENT COMPLETION
10. ACTUAL PERCENT COMPLETION
11. ORIGINAL CONTRACT COMPLETION DATE
REPORT FOR PERIOD ENDING
VA FORM
JUN 2012 10-6001a
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
SUPPLEMENTAL AGREEMENT - ADD
SUPPLEMENTAL AGREEMENT - DEDUCT
TOTAL $$$
CONTRACT FISCAL DATA
CHANGE ORDERS, SUPPLEMENTAL AGREEMENTS, AND TIME EXTENSIONS
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
55A.
55B.
55C.
55D.
56.
57.
58.
59.
60.
CURRENT CONTRACT AMOUNT (From Item 40, Col. B)
VALUE - UNUSED MATERIALS PAID FOR THIS PERIOD
RETAINAGE (Based on Item 45 less cost of bond premiums)
PAYMENT THIS PERIOD
TOTAL PAYMENT TO DATE (Item 47 plus 48)
CO CHANGE ORD., PREV. REPORTED, NO.
ISSUED THIS PERIOD
ISSUED THIS PERIOD
ISSUED THIS PERIOD
ISSUED THIS PERIOD
TO INCL.CO SUPPL. AGREE. PREV. REPORTED, SYM
TO
TO
TO
TO INCL.
INCL.
INCL.
INCL.
51. EQUIPMENT STATUS 52. MATERIALS STATUS 53A. WORK PROGRESS 53B. PROGRESS FACTOR 54. SUBMISSIONS OVERDUE
ITEM
NO.
61. REMARKS
62. SIGNATURE OF RESIDENT ENGINEER 63. DATE
ADDITIONS DEDUCTIONS
(C) (D) (E)
DATE
APPROVED
(B)
DAYS
EXTENSIONSYMBOLS
(A)
VALUE - CONTRACT NOT EARNED (Item 41 minus 45)
VALUE - WORK IN PLACE TO DATE (Item 40, Cols. C plus D)
VALUE - UNUSED MATERIALS PREVIOUSLY PAID FOR
EARNED TO DATE (Items 42 plus 43 plus 44)
TOTAL PREVIOUS PAYMENTS
FIELD SUPPL. AGREE. PREV. REPORTED, NO.
FIELD CHANGE ORD. PREV. REPORTED, SYM.
TIME EXTENS. PREV. REPORTED, NO.
VA FORM
JUN 2012 10-6001a
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average 12 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the form. If your firm does not already have a similar form, this is used to record the data necessary to assure the contractor provides sufficient labor and materials to accomplish the contract work. This form or a similar document is required to guarantee the performance of the work necessary to complete the project.
D:19970130153324Z
CONTRACT PROGRESS REPORT
CONTRACT PROGRESS REPORT
LOCATION OF PROJECT
LOCATION OF PROJECT
TO
TO
Centra Texas Health Care System (CTVHCS) 1901 Memorial Drive Temple, TX 76504 Centra Texas Health Care System (CTVHCS) 1901 Memorial Drive Temple, TX 76504
1. PROJECT NO.
1. PROJECT NO.
2. CONTRACT NO.
2. CONTRACT NO.
3. DATE CONTRACT AWARD
3. DATE CONTRACT AWARD
4. DATE NOTICE TO PROCEED RECEIVED
4. DATE NOTICE TO PROCEED RECEIVED
6. NAME AND ADDRESS OF CONTRACTOR
6. NAME AND ADDRESS OF CONTRACTOR
7. DESCRIPTION OF CONTRACT
7. DESCRIPTION OF CONTRACT
12. EXTENDED CONTRACT COMPLETION DATE
12. EXTENDED CONTRACT COMPLETION DATE
ITEM
NO.
15.
VA FORM
JUN 2012
10-6001a
5. DATE CONST. STARTED
5. DATE CONST. STARTED
BRANCH OF WORK
BRANCH OF WORK
TOTAL VALUE
TOTAL VALUE
VALUE OF WORK IN
PLACE-END LAST PERIOD
VALUE OF WORK IN
PLACE-END LAST PERIOD
VALUE OF WORK INSTALLED
IN CURRENT PERIOD
VALUE OF WORK INSTALLED
IN CURRENT PERIOD
(A) (B) (C) (D) \\iaimain\apps1\Pam_Ward\Logos\Formlogo.jpg Department of Veterans Affairs
13. ESTIMATED COMPLETION DATE
13. ESTIMATED COMPLETION DATE
OMB Approval No. 2900-0208 Estimated burden 12 minutes 16.
17.
18.
19.
20.
21.
22.
23.
14. DATE COMPLETED
14. DATE COMPLETED
8. ORIGINAL CONTRACT AMOUNT
8. ORIGINAL CONTRACT AMOUNT
9. SCHEDULED PERCENT COMPLETION
9. SCHEDULED PERCENT COMPLETION
10. ACTUAL PERCENT COMPLETION
10. ACTUAL PERCENT COMPLETION
11. ORIGINAL CONTRACT COMPLETION DATE
11. ORIGINAL CONTRACT COMPLETION DATE
REPORT FOR PERIOD ENDING
REPORT FOR PERIOD ENDING
VA FORM
JUN 2012
10-6001a 24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
SUPPLEMENTAL AGREEMENT - ADD
38. SUPPLEMENTAL AGREEMENT - ADD
SUPPLEMENTAL AGREEMENT - DEDUCT
39. SUPPLEMENTAL AGREEMENT - DEDUCT
TOTAL
40. TOTAL
CONTRACT FISCAL DATA
CHANGE ORDERS, SUPPLEMENTAL AGREEMENTS, AND TIME EXTENSIONS
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
55A.
55B.
55C.
55D.
56.
57.
58.
59.
60.
CURRENT CONTRACT AMOUNT (From Item 40, Col. B)
41. CURRENT CONTRACT AMOUNT (From Item 40, Col. B)
VALUE - UNUSED MATERIALS PAID FOR THIS PERIOD
44. VALUE - UNUSED MATERIALS PAID FOR THIS PERIOD
RETAINAGE (Based on Item 45 less cost of bond premiums)
46. RETAINAGE (Based on Item 45 less cost of bond premiums)
PAYMENT THIS PERIOD
48. PAYMENT THIS PERIOD
TOTAL PAYMENT TO DATE (Item 47 plus 48)
49. TOTAL PAYMENT TO DATE (Item 47 plus 48)
CO CHANGE ORD., PREV. REPORTED, NO.
55B. CO CHANGE ORD., PREV. REPORTED, NO.
ISSUED THIS PERIOD
57. ISSUED THIS PERIOD
ISSUED THIS PERIOD
58. ISSUED THIS PERIOD
ISSUED THIS PERIOD
59. ISSUED THIS PERIOD
ISSUED THIS PERIOD
60. ISSUED THIS PERIOD
TO
INCL.
CO SUPPL. AGREE. PREV. REPORTED, SYM
55A. CO SUPPL. AGREE. PREV. REPORTED, SYM
TO
TO
TO
TO
INCL.
INCL.
INCL.
INCL.
51. EQUIPMENT STATUS
51. EQUIPMENT STATUS
52. MATERIALS STATUS
52. MATERIALS STATUS
53A. WORK PROGRESS
53A. WORK PROGRESS
53B. PROGRESS FACTOR
53B. PROGRESS FACTOR
54. SUBMISSIONS OVERDUE
54. SUBMISSIONS OVERDUE
ITEM
NO.
61. REMARKS
61. REMARKS
62. SIGNATURE OF RESIDENT ENGINEER
62. SIGNATURE OF RESIDENT ENGINEER
63. DATE
63. DATE
ADDITIONS
ADDITIONS
DEDUCTIONS
DEDUCTIONS
(C) (D) (E)
DATE
APPROVED
DATE APPROVED
(B)
DAYS
EXTENSION
DAYS EXTENSION
SYMBOLS
(A) VALUE - CONTRACT NOT EARNED (Item 41 minus 45)
50. VALUE - CONTRACT NOT EARNED (Item 41 minus 45) VALUE - WORK IN PLACE TO DATE (Item 40, Cols. C plus D)
42. VALUE - WORK IN PLACE TO DATE (Item 40, Cols. C plus D)
VALUE - UNUSED MATERIALS PREVIOUSLY PAID FOR
43. VALUE - UNUSED MATERIALS PREVIOUSLY PAID FOR
EARNED TO DATE (Items 42 plus 43 plus 44)
45. EARNED TO DATE (Items 42 plus 43 plus 44)
TOTAL PREVIOUS PAYMENTS
47. TOTAL PREVIOUS PAYMENTS
FIELD SUPPL. AGREE. PREV. REPORTED, NO.
55C. FIELD SUPPL. AGREE. PREV. REPORTED, NO.
FIELD CHANGE ORD. PREV. REPORTED, SYM.
55D. FIELD CHANGE ORD. PREV. REPORTED, SYM.
TIME EXTENS. PREV. REPORTED, NO.
56. TIME EXTENS. PREV. REPORTED, NO.
VA FORM
JUN 2012
10-6001a The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average 12 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the form. If your firm does not already have a similar form, this is used to record the data necessary to assure the contractor provides sufficient labor and materials to accomplish the contract work. This form or a similar document is required to guarantee the performance of the work necessary to complete the project.
| D40. TOTAL: Jesse Brown VAMC |
| D40. TOTAL: 537-21-113 |
| TextField2: |
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