Features for transmitting the form electronically are
available to those customers with access credentials only. If you would
like to establish online access credentials with USDA, follow the instructions
provided at the USDA eForms web site.
Fld Name / |
Instruction |
1 Contract No |
Enter the contract number relating to the partial payment request. |
2 Partial Payment Estimate No |
Enter the number of the current partial payment being requested. |
3 Page |
Enter page numbers as appropriate. |
4 Owner |
Enter the borrower�s name. |
5 Contractor |
Enter the contractor�s name. |
6 Period of Estimate |
Enter the period: month, day, and year as appropriate, reflective of the current partial payment request. |
7 Contract Change Order Summary |
Enter information requested for all change orders previously approved for this project. |
Estimate |
Instructions |
8 Original Contract |
Enter the original contract amount. |
9 Change Orders |
Enter the amount of the change orders approved. |
10 Revised Contract |
Enter the total of the original contract amount plus the processed change orders. |
11 Work Completed |
Enter the total of the work completed to date from the detailed lump sum price breakdown worksheet section. |
12 Stored Materials |
Enter the amount of stored materials reflective at the end of this payment period itemized on a stored materials and retainage breakdown worksheet section. |
13 Subtotal |
Enter the total of the work completed and the stored materials. |
14 Retainage |
Enter the amount of retainage itemized on a retainage breakdown worksheet section. |
15 Previous Payments |
Enter the amount of previous partial payments approved. |
16 Amount Due |
Enter the difference of the subtotal less the retainage and previous payments made. |
Fld Name / |
Instruction |
17 Contract Time |
Enter the information requested for the original and revised contract time and the number of days remaining. Indicate whether or not the work is on schedule. Show the starting date and projected completion date of the work. |
18 Contractor�s Certification |
Enter the appropriate name, signature, and date for the contractor. |
19 Architect or Engineer�s Certification |
Enter the appropriate name, signature, and date for the architect or engineer. |
20 Borrower�s Signature |
Enter the appropriate name, signature, and date for the borrower. |
21 Accepted by Agency |
Enter the appropriate name, signature, and date for the RD representative. |
Fld Name / |
Instruction |
22 Typical unit price breakdown |
Enter the information requested for the typical unit price breakdown for the entire contract, this period, and total to date, if applicable. |
23 Typical lump sum price breakdown |
Enter the information requested for the typical lump sum price breakdown for the scheduled values, work completed this period, and total to date and percentages of completion, if applicable. |
24 Typical stored materials and retainage breakdown |
Enter the information requested for the typical stored materials and retainage breakdown for materials stored at the end of this payment period. |