Att_13.2_ENG_Form_93.pdf

PAYMENT ESTIMATE - CONTRACT PERFORMANCE

For use of this form, see ER 37-2-10 and 37-345-10; the proponent agency is CERM-FC.

ENG FORM 93, 1 MAR 1978 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 2

b. CONTRACTING OFFICER APPROVAL SIGNATURE

9. PERIOD COVERED BY THIS ESTIMATE (YYYYMMDD)

2. CONTRACTOR AND ADDRESS

1. DATE (YYYYMMDD)

SHEET of

3. CONTRACT NUMBER 4. DISTRICT

5. DESCRIPTION OF WORK 6. APPROPRIATION AND PROJECT 7. REQUIRED COMPLETION DATE (YYYYMMDD)

8. LOCATION 10. JOB ORDER NUMBER 11. ESTIMATE NUMBER

FROM THRU

12.

ITEM

NUMBER

a.

DESCRIPTION

b.

CONTRACT

(1)

QUANTITY AND UNIT

(2)

UNIT PRICE

(3)

AMOUNT

c.

TOTAL TO DATE

(1)

QUANTITY AND UNIT

(2)

AMOUNT

d. INCLUDES MODIFICATION THRU (YYYYMMDD): e. TOTAL CONTRACT > f. TOTAL EARNINGS

TO DATE >

13. PRESENTED FOR PAYMENT

a. PAYEE b. PER

c. DATE (YYYYMMDD) d. TITLE

14. APPROVED FOR PAYMENT

I CERTIFY THAT I HAVE CHECKED THE QUANTITIES COVERED BY THIS BILL OR ESTIMATE;

THAT THE WORK WAS ACTUALLY PERFORMED; AND THE QUANTITIES ARE CORRECT AND

CONSISTENT WITH ALL PREVIOUS COMPUTATIONS AS ACTUALLY CHECKED; THAT THE

QUANTITIES AND AMOUNTS ARE WHOLLY CONSISTENT WITH THE REQUIREMENTS OF THE

CONTRACT OR OTHER INSTRUMENT INVOLVED.

a. TITLE b. DATE (YYYYMMDD)

15a. DATE (YYYYMMDD)

c. SIGNATURE

16a. PREVIOUS DEDUCTIONS OTHER THAN RETAINED PERCENTAGE** (**Page 2)

b. PREVIOUS RETAINED PERCENTAGE

c. PREVIOUS PAYMENTS

d. PREVIOUS EARNINGS (a+b+c)

e. EARNINGS THIS PERIOD (Total Earnings to date minus d)

f. LESS RETAINED PERCENTAGE

h. TOTAL DEDUCTIONS FOR THIS PERIOD (f+g)

g. LESS DEDUCTIONS OTHER THAN

RETAINED PERCENTAGE FOR

i. RETAINAGE REFUNDED

j. OTHER REFUNDS

k. TOTAL REFUNDS THIS PERIOD (i+j)

ENG FORM 93, 1 MAR 1978 Page 2 of 2

SECTION 16 (Continuation)

18. **DETAILED EXPLANATION AND OR REMARKS (Page 1 Item 16a.)

l. AMOUNT DUE CONTRACTOR (e-h+k)

17. RECAPITULATION:

a. TOTAL RETAINED PCTG. (b+f-i)

b. TOTAL PAID (c+l)

SHEET of

PAYMENT ESTIMATE - CONTRACT PERFORMANCE

For use of this form, see ER 37-2-10 and 37-345-10; the proponent agency is CERM-FC.

ENG FORM 93, 1 MAR 1978 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 2

9. PERIOD COVERED BY THIS ESTIMATE (YYYYMMDD)

SHEET of

FROM

THRU

12.

ITEM

NUMBER

a.

DESCRIPTION

b.

CONTRACT

(1)

QUANTITY AND UNIT

(2)

UNIT PRICE

(3)

AMOUNT

c.

TOTAL TO DATE

(1)

QUANTITY AND UNIT

(2)

AMOUNT

d. INCLUDES MODIFICATION THRU (YYYYMMDD):

e. TOTAL CONTRACT >

f. TOTAL EARNINGS

TO DATE >

13. PRESENTED FOR PAYMENT

14. APPROVED FOR PAYMENT

I CERTIFY THAT I HAVE CHECKED THE QUANTITIES COVERED BY THIS BILL OR ESTIMATE; THAT THE WORK WAS ACTUALLY PERFORMED; AND THE QUANTITIES ARE CORRECT AND CONSISTENT WITH ALL PREVIOUS COMPUTATIONS AS ACTUALLY CHECKED; THAT THE QUANTITIES AND AMOUNTS ARE WHOLLY CONSISTENT WITH THE REQUIREMENTS OF THE CONTRACT OR OTHER INSTRUMENT INVOLVED.

16a. PREVIOUS DEDUCTIONS OTHER THAN RETAINED PERCENTAGE** (**Page 2)

b. PREVIOUS RETAINED PERCENTAGE

c. PREVIOUS PAYMENTS

d. PREVIOUS EARNINGS (a+b+c)

e. EARNINGS THIS PERIOD (Total Earnings to date minus d)

f. LESS RETAINED PERCENTAGE

h. TOTAL DEDUCTIONS FOR THIS PERIOD (f+g)

g. LESS DEDUCTIONS OTHER THAN

RETAINED PERCENTAGE FOR

i. RETAINAGE REFUNDED

j. OTHER REFUNDS

k. TOTAL REFUNDS THIS PERIOD (i+j) ENG FORM 93, 1 MAR 1978 Page 2 of 2 SECTION 16 (Continuation)

l. AMOUNT DUE CONTRACTOR (e-h+k)

17. RECAPITULATION:

a. TOTAL RETAINED PCTG. (b+f-i)

b. TOTAL PAID (c+l)

SHEET of 1.1 mark.a.cooper@usace.army.mil 20110815 Form Design Team CEIT-PMO-I ENG FORM 93 Payment Estimate Contract Performance 1 MAR 1978 Mark Cooper ENG FORM 93 Payment Estimate Contract Performance 1 MAR 1978 20110815