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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
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
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)
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TYPICAL UNIT PRICE BREAKDOWN *
CONTRACT (revised)
ITEM
DESCRIPTION
QUANTITY
UNIT
PRICE
THIS PERIOD
COMAMOUNT
TOTALS
QUANTITY
AMOUNT
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
SCHEDULED
VALUE
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
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| File Type | application/pdf |
| File Modified | 2013-06-27 |
| File Created | 2004-08-11 |