RD 1924-18 Partial Payment Estimate

FORM APPROVED
OMB NO. 0575-0042
OMB NO. 0570-NEW

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

__________ OF _________

CONTRACTOR:

PERIOD OF ESTIMATE
FROM _________ TO _________

CONTRACT CHANGE ORDER SUMMARY
No.

Agency Approval
Date

ESTIMATE

Amount
Additions

Deductions

TOTALS
NET CHANGE

1. Original Contract . . . . . . . . . . . . . . . . .

_________________________

2. Change Orders . . . . . . . . . . . . . . . . . .

_________________________

3. Revised Contract (1 + 2) . . . . . . . . . . .

_________________________

4. Work Completed* . . . . . . . . . . . . . . . .

_________________________

5. Stored Materials* . . . . . . . . . . . . . . . . .

_________________________

6. Subtotal (4 + 5) . . . . . . . . . . . . . . . . . .

_________________________

7. Retainage* . . . . . . . . . . . . . . . . . . . . . .

_________________________

8. Previous Payments . . . . . . . . . . . . . . .

_________________________

9. Amount Due (6-7-8) . . . . . . . . . . . . . . .

_________________________

* Detailed breakdown attached

CONTRACT TIME
Original (days) _______________________________
Revised ____________________________________

On Schedule

Remaining __________________________________

CONTRACTOR’S CERTIFICATION:
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.

Yes

Starting Date __________________________________

No

Projected Completion ___________________________

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.

Architect or Engineer ____________________________________
Contractor _____________________________________________
By ________________________________________________
By ________________________________________________
Date _______________________________________________
Date _______________________________________________
APPROVED BY OWNER:

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.

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)

ITEM

ITEM

DESCRIPTION
$

SCHEDULED
VALUE
$

$

THIS PERIOD
$

TO DATE

WORK COMPLETED

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

TOTALS

$

TYPICAL LUMP SUM PRICE BREAKDOWN *

TOTALS

DESCRIPTION

%
COMPLETE

$

AMOUNT

TYPICAL STORED MATERIALS
AND RETAINAGE BREAKDOWN *

QUANTITY

TOTAL TO DATE

TOTAL

OTHER (explain)

STORED MATERIALS:

WORK COMPLETED:

DESCRIPTION

$

UNIT
VALUE
$

THIS ESTIMATE PERCENT
$
% $

RETAINAGE

QUANTITY

%
COMPLETE

RD 1924-18
REVERSE

RETAINED

AMOUNT

MATERIALS STORED AT END OF THIS PAYMENT PERIOD

$

AMOUNT

THIS PERIOD
QUANTITY

TYPICAL UNIT PRICE BREAKDOWN *
CONTRACT (revised)
UNIT
QUANTITY
AMOUNT
PRICE