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Partial Payment Estimate
ICR 202605-0575-002 · OMB 0575-0189 · Object 169300800.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Partial Payment Estimate |
| Last Modified By | Acrobat PDFMaker 21 for Word |
| File Modified | 2021-07-01 |
| File Created | 2021-07-01 |
| Conversion State | complete |
Extracted Text
Close Save Submit 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) Close Save Submit 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] Close Save Submit Close Save Submit 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. Close Save Submit RD 1924-18 REVERSE