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FORM APPROVED
OMB NO. 0575-0042
Exp. Date: MM/DD/YY
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
OWNER:
PAGE
CONTRACTOR:
PERIOD OF ESTIMATE
FROM
CONTRACT CHANGE ORDER SUMMARY
No.
Date
ESTIMATE
Amount
Agency Approval
Additions
TO
1. Original Contract
Deductions
$0.00
2. Change Orders
$0.00
3. Revised Contract (1 + 2)
4. Work Completed*
5. Stored Materials*
$0.00
6. Subtotal (4 + 5)
7. Retainage*
8. Previous Payments
TOTALS
NET CHANGE
$0.00
$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
ARCHITECT OR ENGINEER'S CERTIFICATION:
CONTRACTOR'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
RD 1924-18 (Rev. 6-97)
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A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a
collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control
Number. The OMB Control Number for this information collection is 0575-0042. Public reporting for this collection of information is estimated to be approximately 30
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and
reviewing the collection of information. All responses to this collection of information are voluntary. However, in order to obtain or retain a benefit, the information in
this form is required under Section 7 CFR 1924-A, Planning and Performing Construction and other Development. Rural Development has no plans to publish
information collected under the provisions of this program. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: Information Collection Clearance Officer, Rural Development Innovation Center, Regulations Management Division
at [email protected]
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TYPICAL UNIT PRICE BREAKDOWN *
CONTRACT (revised)
ITEM
DESCRIPTION
QUANTITY
UNIT
PRICE
THIS PERIOD
AMOUNT
TOTALS
QUANTITY
AMOUNT
SCHEDULED
VALUE
DESCRIPTION
COM-
AMOUNT
QUANTITY
PLETE
$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
$0.00
$0.00
$0.00
0
TYPICAL STORED MATERIALS
AND RETAINAGE BREAKDOWN *
TYPICAL LUMP SUM PRICE BREAKDOWN *
ITEM
%
TOTAL TO DATE
WORK COMPLETED
THIS PERIOD
MATERIALS STORED AT END OF THIS PAYMENT PERIOD
%
TO DATE
COMPLETE
DESCRIPTION
QUANTITY
UNIT
VALUE
AMOUNT
0
$0.00
0
$0.00
0
$0.00
0
0
THIS ESTIMATE
0
0 WORK COMPLETED:
0
0
$0.00
RETAINAGE
PERCENT
RETAINED
%
STORED MATERIALS:
0 OTHER (explain)
$0.00
TOTALS
$0.00
$0.00
0
TOTAL
$0.00
* As a minimum, detailed breakdowns should contain this information.
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RD 1924-18
REVERSE
| File Type | application/pdf |
| File Modified | 2021-07-01 |
| File Created | 2021-07-01 |