SAMPLE_-_CAP_Invoice_for_Awarded_Contractor.pdf

v2020.03r12 x

Project No.:

FOR OFFICAL OWNER APPROVAL STAMP

In accordance with the Contract Documents, including but not limited to the plans and specifications, based on on-site observations and the data comprising this application, the Owner's Representative/Supervisory Official hereby certify and solemnly swear or affirm, under penalty of purjury, to the Owner that to the best of their knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the Amount Certified/Due.

AMOUNT CERTIFIED/DUE:

(If Amount Certified/Due is less than Current Payment requested, line 8 above, provide explanation via attachment or notation(s) and notify

Contractor within 7-days.)

CONTRACTOR'S INVOICE AND CERTIFICATION

OWNER'S REPRESENTATIVE / SUPERVISORY OFFICIAL CERTIFICATION

1 is blank

5% Work, then of Remaining Work

I hereby certify and solemnly swear or affirm, under penalty of perjury, that (A) the Work performed and the materials stored on site, as shown herein, represent the actual value of performance on Project under the terms of the Agreement (and all authorized changes thereto) between the undersigned and the Owner; (B) that payments, less applicable retention, have been made through the period covered by previous payments received from the Owner, to (1) all Subcontractors and (2) for all materials and labor used in the performance of the Agreement; and

(C) that I have complied with Federal, State and local tax laws, including Social Security laws, Unemployment Compensation laws, and Worker's Compensation laws insofar as applicable to the performance of the Agreement.

of 50% of Completed

1.Original Contract sum:…………………………… 2.Net change by Change Orders:……………………

(from Net changes by Change Order above)

Contract Funds to Finish:

Project Duration Progress:-$

AMENDMENTS / CHANGE ORDERS

Changes approved in previous months:

Changes approved this month:

Totals:

Net Changes To Contract Price:

ADDITIONS

SC is blankContract Time Remaining:

NTP is blankContract Time:DEDUCTIONS

Substantial Completion:

(Period from)

(Period to)

(Purchase Order No.)

NTP Date:

Oklahoma City, OK 73105

To Owner: From Contractor:

Via Owner's Representative (Consultant):

State of Oklahoma OMES/CAM

Attn:

For Project:

Contractor Invoice

Project No.:

-$ 2.5%

SCHEDULE

Final Payment?

Office of Management & Enterprise Services ■ Capital Assets Management ■ Department of Real Estate Services ■ Construction and Properties

CAP Project No.:

2401 N Lincoln Blvd. Suite 212 DRES/Construction & Properties

FOR OFFICIAL STATE RECEIVED STAMP

Progress Payment?

APPLICATION

(Application Number)

(Application Date)

(Authorized Representative Signature) (Date signed)

(Owner's Representative Firm/Supervisory Official's Using Agency Printed Name)

(Authorized Representative Printed Name)

(Authorized Representative Signature) (Date signed)

8.Current Payment requested:……………… (Line 6 less line 7)

9.Balance to finish, including Retainage:………… (Line 3 less line 6)

(Authorized Representative Printed Name)

(Column D+E +F on G703)

6.Total earned less Retainage:……………………… (Line 4 less line 5)

7.Less Previous Application for Payment:……… (Line 6 from previous Application for Payment)

3.Contract Sum to date:…………………………………….

(Line 1 plus line 2)

4.Total Completed and Stored to date:…………..

(Column G total on G703)

5. Retainage:

% Complete

CAP Form G702 (10/2020) CONTRACTOR INVOICE W/CERTIFICATIONS - PAGE 1 OF 4 x

A C D E F G H

From Previous Application (D+E)

This Period

1 Note: Fields are -$ -$

2 split to allow for indentation. -$ -$

3 -$ -$

4 -$ -$

5 -$ -$

6 -$ -$

7 -$ -$

8 -$ -$

9 -$ -$

10 -$ -$

11 -$ -$

12 -$ -$

13 -$ -$

14 -$ -$

15 -$ -$

16 -$ -$

17 -$ -$

18 -$ -$

19 -$ -$

20 -$ -$

21 -$ -$

22 -$ -$

23 -$ -$

24 -$ -$

25 -$ -$

26 -$ -$

27 -$ -$

28 -$ -$

29 -$ -$

30 -$ -$

31 -$ -$

Totals -$ -$ -$ -$ -$ -$ x

Ex cl ud ed

Item Scheduled Value Work Completed Materials Presently

Stored (Not In D Or E)

Total Completed And Stored To Date

(D+E+F) % (G÷C)

Balance To Finish (C- G)

Description Of Work

B

(Application No.)

(Application Date)

Contractor Invoice (Continuation - Schedule of Values)

Office of Management & Enterprise Services ■ Capital Assets Management ■ Department of Real Estate Services ■ Construction and Properties

(CAP Project No)

CAP Form G702 Contractor Invoice , containing Contractor's signed Certification and Owner's Representative/Supervisory Official's Certification is required to be attached and completed fully to be considered Proper Invoice.

*Mark "Excluded" column with an "x" if line is to be excluded from Retainage calculations. (Project Name) (Purchase Order No.)

CAP FORM G703 (10/2020) 3/5/2024 CONTRACTOR INVOICE (CONTINUATION - SCHEDULE OF VALUES) - PAGE 1 OF 1

GENERAL INFORMATION

NOTE

The reverse engineering, breaking, modification or alteration of this form shall be interpreted as, at a minimum, an Invoice that is not Proper and rejected, or a Breach of Contract.

Contractor Invoice Instructions

Purpose and Related Documents. CAP Form G702 Contractor Invoice , is to be used in conjunction with CAP Form G703 Continuation - Schedule of Values . These documents are designed to be used on a Project where a Contractor has a direct Agreement with the Owner. Procedures for their use are covered in CAP Form A201 General Conditions of the Contract for Construction .

Reproductions. This document is a modified form of AIA Document G702 and has been edited under license issued to the State of Oklahoma. This form may be copied or computer generated, but not altered.

COMPLETING THE G702 FORM

After the Contractor has completed CAP Form G703 Continuation - Schedule of Values , summary info, information should be transferred to CAP Form G702 Contractor Invoice .

Office of Management & Enterprise Services ■ Capital Assets Management ■ Department of Real Estate Services ■ Construction and Properties

The Owner should make payment directly to the Contractor based on the amount certified by the Onwer's Representative on CAP Form G702 Contractor Invoice . The completed form should contain the name and address of the Contractor. Payment should not be made to any other party unless specifically agreed to in writing.

EXECUTION OF THE DOCUMENT

Persons executing the document should indicate the capacity in which they are acting (i.e., president, secretary, partner etc.) and the authority under which they are executing the document. Where appropriate a copy of the resolution authorizing the individual to act on behalf of the firm or entity should be attached.

The Contractor signs the G702 and submits it, together with G703, to the Owner's Representative (Consultant).

The Owner's Representative should review G702 and G703 and, if they are acceptable, complete the Certificate for Payment on G702.

The Owner's Representative may certify a different amount than that applied for, pursuant to Sections 9.5 and 9.6 of A201. The Owner's Representative should then initial all figures on G702 and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 and G703 should be forwarded to the Using Agency for acceptance and then the Owner for approval.

MAKING PAYMENT

CAP FORM G702 (03/2020) CONTRACTOR INVOICE INSTRUCTION - 1 OF 1

GENERAL INFORMATION

NOTE

Column C: should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project, Office of Management & Enterprise Services ■ Capital Assets Management ■ Department of Real Estate Services ■ Construction and Properties

The reverse engineering, breaking, modification or alteration of this form shall be interpreted as, at a minimum, an Invoice that is not Proper and rejected, or a Breach of Contract.

Heading: This Information should be completed in a manner consistent with similar information CAP Form G702 Contractor Invoice.

Purpose and Related Documents. CAP Form G702 Contractor Invoice , is to be used in conjunction with CAP Form G703 Continuation - Schedule of Values , These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in CAP Form A201 General Conditions of the Contract for Construction .

Continuation - Schedule of Values Instructions

The following is an example of a Continuation Sheet for work in progress, Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs.

Column Excluded: An "x" should be placed within this column if the line item is exempt from retainage, i.e. phase underwent Substantial Completion, end of Preconstruction (CMc) phase billing.

Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not the State's method.Change Orders are to be listed separately at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.

Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201.

Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed-This Period.)

Column G: This is done automatically - the total of columns D, E and F are calculates and the percentage completed, by dividing column G by column C, is in adjacent column.

Column H: This is done automatically - the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date) is calculated.

Column D: Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column.

Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F).

Reproductions. This document is a modified form of AIA Document G703 and has been edited under license issued to the State of Oklahoma. This form may be copied or computer generated, but not altered.

COMPLETING THE G703 FORM

Columns A, B & C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Owner's Representative (Consultant) at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.

A B C D E F G H

WORK COMPLETED

ITEM

NO.

DESCRIPTION OF WORK

SCHEDULED

VALUE

FROM

PREVIOUS

APPLICATION

(D + E)

THIS PERIOD

MATERAILS

PRESENTLY

STORED

(NOT IN

D OR E)

TOTAL

COMPLETED

AND STORED

TO DATE

(D+E+F)

(G / C)

BALANCE TO

FINISH

(C – G)

(IF VARIABLE

1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0

2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0

3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0

4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000

5 CURBS & MISC CONC. 5,000 0 0 0 0 0 5,000

6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000

7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000

8 PAVERS 20,000 0 0 10,000 10,000 50 10,000

9 BRICK WORK 5,000 0 0 0 0 0 5,000

Total 105,000 20,000 10,000 10,000 40,000 65,000

CAP Form G703 (03/2020) COTINUATION - SCHEDULE OF VALUES INSTRUCTIONS - 1 OF 1