Subcontractor_Payment_Substantiation_Form_WY_1510-1.pdf

PDF 10 KB Posted

Attached to
BUFFALO FO JANITORIAL Federal contract opportunity
Solicitation number
140L6223R0001
Issued by
Department of the Interior Bureau of Land Management Wyoming Region

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Text version

SUBCONTRACTOR PAYMENT SUBSTANTIATION

Contract number: ________________________

Contract title: ___________________________

Prime Contractor (name, address, ZIP):

Progress PAYMENT NUMBER: ________

Progress Payment invoice amount: $____________________

Subcontract number: ____________________

Subcontractor (name, address, ZIP):

1. Original subcontract amount: $____________________

2. Changes by modification: Mod. No. ___ $____________________

Mod. No. ___ $____________________

Mod. No. ___ $____________________

3. Total subcontract amount: $____________________

4. Subcontract amount previously paid: $____________________

5. Subcontract amount in current progress payment request: $____________________

6. Total subcontractor amount which will have been paid on receipt of this progress payment: $____________________

7. Subcontract amount remaining: $____________________

Name & Title of person signing Signature Date

(prime contractor)

Form WY 1510-1

(01/05)

File details come from the government source that posted it. Updated .