Partial Payment Estimate

FORM APPROVED
OMB NO. 0575-0042

Form RD 1924-18
(Rev. 6-97)

CONTRACT NO.

UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT
FARM SERVICE AGENCY

PARTIAL PAYMENT ESTIMATE NO.

PARTIAL PAYMENT ESTIMATE
PAGE
OWNER:

CONTRACTOR:

PERIOD OF ESTIMATE

FROM
CONTRACT CHANGE ORDER SUMMARY
Agency Approval
No.

Date

ESTIMATE

Amount
Additions

TO

1. Original Contract
Deductions

2. Change Orders

$0.00

3. Revised Contract (1 + 2)

$0.00

4. Work Completed*
5. Stored Materials*
$0.00

6. Subtotal (4 + 5)
7. Retainage*
8. Previous Payments
TOTALS

$0.00

NET CHANGE

$0.00

$0.00

9. Amount Due (6-7-8)

$0.00
$0.00

* Detailed breakdown attached

CONTRACT TIME
Original (days)
Revised

On Schedule

Yes

Starting Date

No

Projected Completion

Remaining

CONTRACTOR'S CERTIFICATION:

ARCHITECT OR ENGINEER'S CERTIFICATION:

The undersigned certifies that the work has been carefully
inspected and to the best of their knowledge and belief, the
quantities shown in this estimate are correct and the work has
been performed in accordance with the contract documents.

The undersigned Contractor certifies that to the best of their
knowledge, information and belief the work covered by this
payment estimate has been completed in accordance with
the contract documents, that all amounts have been paid by
the contractor for work for which previous payment estimates
was issued and payments received from the owner, and that
current payment shown herein is now due.

Architect or Engineer
Contractor
By
By
Date
Date
ACCEPTED BY AGENCY:

The review and acceptance of this estimate does not attest to
the correctness of the quantities shown or that the work has
been performed in accordance with the contract documents.

APPROVED BY OWNER:

Owner
By
By

Title

Date

Date

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0575-0042. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information.

RD 1924-18 (Rev. 6-97)

TYPICAL UNIT PRICE BREAKDOWN *
CONTRACT (revised)
ITEM

DESCRIPTION
QUANTITY

UNIT
PRICE

THIS PERIOD

COMAMOUNT

TOTALS

QUANTITY

AMOUNT

SCHEDULED
VALUE

PLETE

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

$0.00

$0.00

$0.00

0

TYPICAL STORED MATERIALS
AND RETAINAGE BREAKDOWN *
WORK COMPLETED

DESCRIPTION

AMOUNT

QUANTITY

$0.00

TYPICAL LUMP SUM PRICE BREAKDOWN *

ITEM

%

TOTAL TO DATE

MATERIALS STORED AT END OF THIS PAYMENT PERIOD

%
COM-

THIS PERIOD

TO DATE

PLETE

DESCRIPTION

QUANTITY

UNIT
VALUE

AMOUNT

0

$0.00

0

$0.00

0

$0.00

0

$0.00
RETAINAGE

0

THIS ESTIMATE

0

PERCENT

RETAINED

%

0 WORK COMPLETED:
0
0
0
TOTALS

$0.00

$0.00

$0.00

0

STORED MATERIALS:
OTHER (explain)
TOTAL

$0.00

* As a minimum, detailed breakdowns should contain this information.

RD 1924-18
REVERSE