Filetype Excel XLSX | Posted on 14 Aug 2022 | 3 years ago
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204x Filetype XLSX File size 0.04 MB Source: dgs.dc.gov
Sheet 1: Instructions
| Instructions to Vendors | ||||||||||
| This worksheet contains formulas that calculate the appropriate amount due for work performed. To ensure the prompt payment of invoices, contractors are advised not to alter fields containing formulas. Errors in the calculations of the amount due will result in submissions being rejected resulting in a delay of payment. | ||||||||||
| Summary Progress Cover Sheet | ||||||||||
| Vendors are to complete fields highlighed in yellow. | ||||||||||
| Date Submitted | Vendor Invoice # | Vendor Signature | ||||||||
| Contract # | Purchase Order #: | Printed name | ||||||||
| Project Name | Contract Start & End Dates | Title | ||||||||
| Contractor | Billing Start and End Dates | Date | ||||||||
| Pay Request Form | ||||||||||
| Vendors are to complete columns highlighted in yellow. Complete the Pay Request Form to match the line items on your PO. | ||||||||||
| CO#/ Mod# (drop-down menu provided) | Enter the change order number if the line corresponds to change order work. Leave blank if line is original/base contract work. | |||||||||
| Description | Enter a description from PO for line item | |||||||||
| Contract Amount | Enter line item cost from PO | |||||||||
| Previous Work Value | Enter total complete amount for this line item from previous invoices | |||||||||
| Work This Invoice Value | Enter cost of completed work in this invoice period for this line item | |||||||||
| Stored Material This Invoice Value | Enter the stored material value for this invoice | |||||||||
| General Retainage Percent | Enter the General retainage amount for each line used | |||||||||
| Previous Retainage Percent | Enter the percentage held for retainage in the previous invoice | |||||||||
| Date Submitted: | ||||||||||
| Contract #: | ||||||||||
| Project Name: | Contract Start Date: | |||||||||
| Contractor: | Contract Completion Date: | |||||||||
| Vendor Invoice #: | Billing Start: | Billing End: | ||||||||
| 1. Original Contract Amount | $0.00 | |||||||||
| 2. Net Amount of Change Orders Approved | $0.00 | |||||||||
| 3. Total Contract Amount To Date (1+2) | $0.00 | |||||||||
| 4. Total Amount Completed % | 0.00% | $0.00 | ||||||||
| 5.Retainage: | 0.00% | $0.00 | ||||||||
| 6.Less Previous Payments | ||||||||||
| TOTAL AMOUNT DUE THIS PAYMENT | $0.00 | |||||||||
| Balance to Finish | 0.00% | - | ||||||||
| CONTRACTOR'S (GC) CERTIFICATE: I Certify that all items, quantities and prices of work and material shown in the application for payment are correct to the best of my knowledge and belief and have been completed in accordance with the Contract Documents. ARCHITECT'S (A/E) / CONSTRUCTION MANAGER (CM) CERTIFICATE: In accordance with the Contract Documents, based on site observation and data comprising this application, the A/E / CM certifies to the owner to the best of the A/E / CM's knowledge, information and belief the work has progressed as indicated, the quality of the work is in accordance with Contract Documents, and the contractor is entitled to payment of the AMOUNT CERTIFIED. CERTIFICATION OF TIMELY PAYMENTS TO SUBCONTRACTORS AND SUPPLIES: I will make timely payments from the proceeds of this payment to all subcontractors and suppliers in accordance with my contractual arrangements with them. I have made payment from proceeds of prior payments to all subcontractors and suppliers in accordance with my contractual arrangements with them. |
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| Vendor Signature | ||||||||||
| Project Manager | By: | |||||||||
| Printed name | ||||||||||
| Program Manager | Title | Date | ||||||||
| DC CERTIFICATE: I certify that o the best of my knowledge and belief, this requisition is a true and correct statement of work performed and materials supplied by the contractor and that the work and materials comply with the requirements of the contract. I also certify that all of the required certified payroll affidavits have been received. | ||||||||||
| Cluster Leader | Deputy Director | Chief Project Delivery Officer | ||||||||
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