Академический Документы
Профессиональный Документы
Культура Документы
CP 0191 Payment Certification
Загружено:
tabaquiОригинальное название
Авторское право
Доступные форматы
Поделиться этим документом
Поделиться или встроить документ
Этот документ был вам полезен?
Это неприемлемый материал?
Пожаловаться на этот документАвторское право:
Доступные форматы
CP 0191 Payment Certification
Загружено:
tabaquiАвторское право:
Доступные форматы
SUMMARY
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: Refer to the individual projects Project No.: Refer to the individual projects
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: SUMMARY DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: 0.00% $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
SUMMARY FOR ALL PROJECTS To
Contractor's Name Invoice Date
0 1-Jan-04
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
REFER TO EACH INDIVIDUAL PROJECT FOR AUTHORIZATION SIGNATURE
Design Consultant's Signature Please print Design Consultant's Name & Company Date
REFER TO EACH INDIVIDUAL PROJECT FOR AUTHORIZATION SIGNATURE
Inspector of Record's Signature Please print Inspector of Record's Name Date
REFER TO EACH INDIVIDUAL PROJECT FOR AUTHORIZATION SIGNATURE
College Project Director's (CPD) Signature Please print CPD's Name Date
REFER TO EACH INDIVIDUAL PROJECT FOR AUTHORIZATION SIGNATURE
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
SUMMARY
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04
Project Name: SUMMARY FOR ALL PROJECTS Contract No.: 0
Project No.: SUMMARY FOR ALL PROJECTS Payment Req. No.: SUMMARY
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of From Previous Earned This Period Earned To Date
Division Detailed Item of Work
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: SUMMARY FOR ALL PROJECTS Contract No.: 0
Project No.: SUMMARY FOR ALL PROJECTS Payment Req. No.: SUMMARY
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of From Previous Earned This Period Earned To Date
Division Detailed Item of Work
Division % Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment
Process Gas and Liquid Handling, 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Insurance 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
SUMMARY
ED FOR ALL METHODS OF EXECUTION
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: SUMMARY FOR ALL PROJECTS Contract No.:
Project No.: SUMMARY FOR ALL PROJECTS Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: SUMMARY FOR ALL PROJECTS Performance Dates:
Project Name: SUMMARY FOR ALL PROJECTS Contract No.:
Project No.: SUMMARY FOR ALL PROJECTS Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: SUMMARY FOR ALL PROJECTS Contract No.:
Project No.: SUMMARY FOR ALL PROJECTS Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
SUMMARY 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
SUMMARY 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
SUMMARY 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: 0.00% $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount %
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
01 General Requirements 0.00 0.00% 0.00 0.00% 0.00 0.00%
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00%
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00%
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00%
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00%
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00%
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00%
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00%
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00%
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00%
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00%
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00%
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00%
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00%
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00%
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00%
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00%
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00%
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00%
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00%
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00%
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00%
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00%
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount %
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00%
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00%
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00%
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00%
41 Material Processing & Handling Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
42 Process Heating, Cooling & Drying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
Process Gas and Liquid Handling, Purification and
43 Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33%
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28%
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00
Pre-Const. / Design Division Total: 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
ACTOR PAYMENT CERTIFICATION
TRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
LED ITEMS OF WORK Sht. 1 of 2
E USED FOR ALL METHODS OF EXECUTION
To
Invoice Date
City State Zip Code
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
TRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
LED ITEMS OF WORK Sht. 2 of 2
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 6.67% 0.00
0.00 69.72% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work ha
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amoun
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been rec
Project Name: 0 Project No.:
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN
1. Original Contract Value $0.00
2. Executed Change Order Value Additive $0.00
Deductive $0.00
3. Current Contract Value $0.00
(a) Total Earned to date (from Original Contract value) $0.00
(b) Total Earned to date on Executed Change Orders $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00
(d) Total Earned This Period $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00
(g) Total Amount Retained or Amount Approved by District $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00
6. Percentage Complete #DIV/0!
0
Contractor's Name
Design Build Contractor's Signature Please print name and title
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify that this progress payment does not exceed the value (less % retained from 'e') of the work completed since th
value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify tha
work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (le
Design Consultant's Signature Please print Design Consultant's Name & Company
Inspector of Record's Signature Please print Inspector of Record's Name
College Project Director's (CPD) Signature Please print CPD's Name
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name
Form CP-0191 Page 1 of 1
N
ED REPRESENTATIVE
EXECUTION
st are correct; that all work has been performed and materials supplied in full
tement of the contract amount up to and including the last day of the period
yment Request" has been received:
CONSTRUCTION TOTAL
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
#DIV/0! #DIV/0!
1-Jan-04
Invoice Date
`
name and title Date
N
ONTRACT
of the work completed since the previous progress payment, if any, plus the
alled, if any. I further certify that this progress payment covers full payment for
does not exceed the value (less % retained from 'e') of the materials.
Date
Date
Date
Date
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount %
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
01 General Requirements 0.00 0.00 0.00% 0.00 0.00%
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00%
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00%
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00%
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00%
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00%
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00%
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00%
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00%
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00%
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00%
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00%
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00%
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00%
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00%
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00%
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00%
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00%
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00%
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00%
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00%
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00%
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00%
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount %
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00%
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00%
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00%
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00%
41 Material Processing & Handling Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
42 Process Heating, Cooling & Drying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
Process Gas and Liquid Handling, Purification
43 and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00%
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00%
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33%
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28%
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00
Pre-Const. / Design Division Total: 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
ACTOR PAYMENT CERTIFICATION
TRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
LED ITEMS OF WORK Sht. 1 of 2
E USED FOR ALL METHODS OF EXECUTION
To
Invoice Date
City State Zip Code
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
TRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
LED ITEMS OF WORK Sht. 2 of 2
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 6.67% 0.00
0.00 69.72% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount % Amount
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount % Amount
0 Demolition of Netting Poles 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount % Amount
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Construction Additive CO Totals: 0.00 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
AYMENT CERTIFICATION
OR HIS DULY AUTHORIZED REPRESENTATIVE
ORTING CONTRACT PAYMENT REQUEST
FOR ALL METHODS OF EXECUTION
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
ers Approved by Board of Trustees
ESIGN PHASE CHANGE ORDERS
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
0.00
0.00
0.00
Rev. 02.06.15
AYMENT CERTIFICATION
OR HIS DULY AUTHORIZED REPRESENTATIVE
ORTING CONTRACT PAYMENT REQUEST
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
ers Approved by Board of Trustees
PHASE CHANGE ORDERS
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
AYMENT CERTIFICATION
OR HIS DULY AUTHORIZED REPRESENTATIVE
ORTING CONTRACT PAYMENT REQUEST
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
ers Approved by Board of Trustees
PHASE CHANGE ORDERS
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Process Gas and Liquid Handling,
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33% 0.00
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
ED FOR ALL METHODS OF EXECUTION
To
Invoice Date
State Zip Code
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
6.67% 0.00
69.72% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Process Gas and Liquid Handling,
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33% 0.00
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
ED FOR ALL METHODS OF EXECUTION
To
Invoice Date
State Zip Code
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
6.67% 0.00
69.72% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Process Gas and Liquid Handling,
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33% 0.00
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
ED FOR ALL METHODS OF EXECUTION
To
Invoice Date
State Zip Code
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
6.67% 0.00
69.72% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Process Gas and Liquid Handling,
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33% 0.00
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
ED FOR ALL METHODS OF EXECUTION
To
Invoice Date
State Zip Code
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
6.67% 0.00
69.72% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Process Gas and Liquid Handling,
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33% 0.00
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
ED FOR ALL METHODS OF EXECUTION
To
Invoice Date
State Zip Code
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
6.67% 0.00
69.72% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Process Gas and Liquid Handling,
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33% 0.00
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
ED FOR ALL METHODS OF EXECUTION
To
Invoice Date
State Zip Code
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
6.67% 0.00
69.72% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Dat
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Dat
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Dat
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
TOR PAYMENT CERTIFICATION
ACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
SUPPORTING CONTRACT PAYMENT REQUEST
USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
ge Orders Approved by Board of Trustees
ON / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
TOR PAYMENT CERTIFICATION
ACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
ge Orders Approved by Board of Trustees
TION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
TOR PAYMENT CERTIFICATION
ACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
ge Orders Approved by Board of Trustees
TION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in full
accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the period
covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress payment
covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from 'e') of the
materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Process Gas and Liquid Handling,
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33% 0.00
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
ED FOR ALL METHODS OF EXECUTION
To
Invoice Date
State Zip Code
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
6.67% 0.00
69.72% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
To the best of my knowledge and belief, I certify that all items, units, quantities, and prices of work shown on this Payment Request are correct; that all work has been performed and materials supplied in
full accordance with the terms and conditions of the construction contract on this project; that the following is a true and correct statement of the contract amount up to and including the last day of the
period covered by this estimate and that no part of the "Total Amount Payable This Contract Payment Request" has been received:
Project Name: 0 Project No.: 0
PRE-CONSTRUCTION /
Contract No.: 0 Invoice No.: 0 DESIGN CONSTRUCTION TOTAL
1. Original Contract Value $0.00 $0.00 $0.00
2. Executed Change Order Value Additive $0.00 $0.00 $0.00
Deductive $0.00 $0.00 $0.00
3. Current Contract Value $0.00 $0.00 $0.00
(a) Total Earned to date (from Original Contract value) $0.00 $0.00 $0.00
(b) Total Earned to date on Executed Change Orders $0.00 $0.00 $0.00
(c) Total Earned (sum of 'a' and 'b') $0.00 $0.00 $0.00
(d) Total Earned This Period $0.00 $0.00 $0.00
(e) Amount to be Retained or Amount Approved by District
Enter Percentage (%) to be Retained: $0.00 $0.00 $0.00
(f) Amount Previously Retained ('g' from previous invoice)
If Final Issuance of Retention enter zero $0.00 $0.00 $0.00
(g) Total Amount Retained or Amount Approved by District $0.00 $0.00 $0.00
(h) Total Payment Allowed to Date ('c' minus 'g') $0.00 $0.00 $0.00
(i) Less Previous Payment (item 'h' from prior claim) $0.00 $0.00 $0.00
(j) Total Amount Payable This Contract Payment Request ('h' minus 'i') $0.00 $0.00 $0.00
4. Amount remaining in Contract / Retention / Escrow ('3' minus 'h') $0.00 $0.00 $0.00
5. Contract Value Remaining to be Invoiced ('3' minus 'c') $0.00 $0.00 $0.00
6. Percentage Complete #DIV/0! #DIV/0! #DIV/0!
0 1-Jan-04
Contractor's Name Invoice Date
Design Build Contractor's Signature Please print name and title Date
CONTRACTOR PAYMENT CERTIFICATION
CERTIFIED AND APPROVED AS PER TERMS OF CONTRACT
To the best of my knowledge and belief, I certify under penalty of perjury that this progress payment does not exceed the value (less % retained from 'e') of the work completed since the previous progress
payment, if any, plus the value (less % retained from 'e') of acceptable, prefabricated materials delivered to the job for incorporation into work, but not installed, if any. I further certify that this progress
payment covers full payment for work completed since the previous progress payment, and that any payment for prefabricated materials stored on the site does not exceed the value (less % retained from
'e') of the materials.
Design Consultant's Signature Please print Design Consultant's Name & Company Date
Inspector of Record's Signature Please print Inspector of Record's Name Date
College Project Director's (CPD) Signature Please print CPD's Name Date
PMO Regional Program Liason's (RPL) Signature Please print RPL's Name Date
Form CP-0191 Page 1 of 1 Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 1 of 2
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: Performance Dates:
Project Name: Contract No.:
Project No.: Payment Req. No.:
Contractor: City
Address:
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
N/A Pre-Construction / Design 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
01 General Requirements 0.00 0.00 0.00% 0.00 0.00% 0.00
02 Site Construction / Existing Conditions 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
02A Asbestos Abatement 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
03 Concrete 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
04 Masonry 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
05 Metals 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
06 Wood, Plastic and Composites 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
07 Thermal and Moisture Protection 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
08 Doors & Windows / Openings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
09 Finishes 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
10 Specialties 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
11 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
12 Furnishings 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
13 Special Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
14 Conveying Systems / Conveying Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
15 (Refer to Division 23) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
16 (Refer to Division 26) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
21 Fire Suppression 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
22 Plumbing 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
23 Heating, Ventilating & A/C (HVAC) 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
25 Integrated Automation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
26 Electrical 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
27 Communication 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
28 Electronic Safety & Security 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
31 Earthwork 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
32 Exterior Improvements 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Form CP-0191 Page 1 of 2
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
DETAILED ITEMS OF WORK Sht. 2 of 2
College: 0 Performance Dates: 1-Jan-04
Project Name: 0 Contract No.: 0
Project No.: 0 Payment Req. No.: 0
Contractor: 0 City
Address: 0 0
Work Completed
Total Value of
Division Detailed Item of Work From Previous Earned This Period Earned To Date
Division
% Amount % Amount % Amount
33 Utilities 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
34 Transportation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
35 Waterway and Marine Construction 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
40 Process Integration 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
41 Material Processing
Process & Handling
Heating, Cooling Equipment
& Drying 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
42 Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
Process Gas and Liquid Handling,
43 Purification and Storage Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
44 Pollution and Waste Control Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
45 Industry-Specific Manufacturing Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
46 Water and Wastewater Equipment 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
48 Electrical Power Generation 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
N/A Not Used 0.00 0.00% 0.00 0.00% 0.00 0.00% 0.00
00610 Payment & Performance Bond 0.00 93.33% 0.00 0.00% 0.00 93.33% 0.00
00610 Insurance 0.00 30.28% 0.00 0.00% 0.00 30.28% 0.00
Pre-Const. / Design Division
Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Pre-Const. / Design Division
Total: 0.00 0.00 0.00 0.00
Construction Division Subtotal: 0.00 0.00 0.00 0.00
Overhead & Profit @ 0.00% 0.00 0.00 0.00 0.00
Construction Division Total: 0.00 0.00 0.00 0.00
Form CP-0191 Page 2 of 2
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 1 of 2
ED FOR ALL METHODS OF EXECUTION
To
Invoice Date
State Zip Code
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
Rev. 02.06.15
R PAYMENT CERTIFICATION
TOR OR HIS DULY AUTHORIZED REPRESENTATIVE
TEMS OF WORK Sht. 2 of 2
To 1-Jan-04
Invoice Date
1-Jan-04
State Zip Code
0 0
Balance of Work to
Complete
% Amount
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
100.00% 0.00
6.67% 0.00
69.72% 0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
PRE-CONSTRUCTION / DESIGN PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Pre-Const. / Design Additive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design Deductive CO Totals: 0.00 0.00 0.00
Pre-Const. / Design CO Subtotals: 0.00 0.00 0.00
0.00 0.00 0.00
Form CP-0191 Page 1 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Form CP-0191 Page 2 of 3
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
College: 0 Performance Dates:
Project Name: 0 Contract No.:
Project No.: 0 Payment Req. No.:
Contractor: 0 City
Address: 0 0
List only those Change Orders Approved by Board of Trustees
CONSTRUCTION PHASE CHANGE ORDERS
Work Completed
Change Order
Description Total Value From Previous Earned This Period Earned To Date
No.
% Amount % Amount %
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
0.00 0.00% 0.00 0.00% 0.00 0.00%
Construction Additive CO Totals: 0.00 0.00 0.00
Construction Deductive CO Totals: 0.00 0.00 0.00
Construction CO Subtotals: 0.00 0.00 0.00
Contract Change Order Total: 0.00
Form CP-0191 Page 3 of 3
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
BE USED FOR ALL METHODS OF EXECUTION
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
CTION / DESIGN PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
Rev. 02.06.15
ACTOR PAYMENT CERTIFICATION
NTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
ATA SUPPORTING CONTRACT PAYMENT REQUEST
1-Jan-04 To 1-Jan-04
0 Invoice Date
0 1-Jan-04
City State Zip Code
0 0 0
hange Orders Approved by Board of Trustees
UCTION PHASE CHANGE ORDERS
Work Completed Balance of Work to
Earned To Date Complete
Amount % Amount
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 100.00% 0.00
0.00 0.00
0.00 0.00
0.00 0.00
Rev. 02.06.15
CONTRACTOR PAYMENT CERTIFICATION
CERTIFICATION OF THE CONTRACTOR OR HIS DULY AUTHORIZED REPRESENTATIVE
CHANGE ORDER (CO) DATA SUPPORTING CONTRACT PAYMENT REQUEST
THIS FORM IS TO BE USED FOR ALL METHODS OF EXECUTION
College: 0 Performance Dates: 1-Jan-04 To To
Project Name: 0 Contract No.: 0 Invoice Date
Project No.: 0 Payment Req. No.: 0 1-Jan-04
Contractor: 0 City State Zip Code
Address: 0 0 0 0
PRE_CONSTRUCTION & DESIGN PHASE
Amount Due
Total Work Work
Contractual This Period Balance To Retention To
No. Fee - Phase SOV's % Complete Completed & Completed Completed This
% Allocation (Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 Execution of Contract 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 Schematic Design Phase and Validation Phase 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 50% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 100% Design Development Phase 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 50% Construction Document Phase 20% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 100% Construction Document Phase 5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 DSA Approval (Stamp Out) of final Construction Docs 10% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 Construct. Administration 15% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 DSA Certification Completed & Submitted to DSA 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 DSA Final Certification Received 2.5% $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL BASIC DESIGN (Contractual) $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Amount Due
Total Work Work
This Period Balance To Retention To
No. Change Orders SOV's % Complete Completed & Completed Completed This
(Less 0% Finish Date
Stored To Date Previous Period Period
Retention)
1 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
2 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
3 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
4 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
5 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
6 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
7 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
8 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
9 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
10 $ - #DIV/0! $ - $ - $ - $ - $ - $ -
SUBTOTAL DESIGN CHANGE ORDERS $ - #DIV/0! $ - $ - $ - $ - $ - $ -
PRE-CONSTRUCTION / DESIGN PHASE TOTAL $ - #DIV/0! $ - $ - $ - $ - $ - $ -
Form CP-0191 Page 1 of 1 Rev. 02.20.15
Вам также может понравиться
- Korean Business Dictionary: American and Korean Business Terms for the Internet AgeОт EverandKorean Business Dictionary: American and Korean Business Terms for the Internet AgeОценок пока нет
- IPA For Construction (Payment Application)Документ1 страницаIPA For Construction (Payment Application)D DonОценок пока нет
- Billing Certificate SampleДокумент1 страницаBilling Certificate SampleGenevieve GayosoОценок пока нет
- Payment CertificationДокумент2 страницыPayment CertificationMohammad UmmerОценок пока нет
- Schedule 9 - Form of Progress Payment ClaimДокумент2 страницыSchedule 9 - Form of Progress Payment ClaimMandalinaQitryОценок пока нет
- One Page M&A Simple Model Improved BlankДокумент21 страницаOne Page M&A Simple Model Improved BlankAllen FengОценок пока нет
- Loan Cost Optimizer Free Download 1Документ13 страницLoan Cost Optimizer Free Download 1sdohtem7Оценок пока нет
- Cloud Migration Cost EstimationДокумент4 страницыCloud Migration Cost EstimationDaniel LettaОценок пока нет
- DD Aia g702 g703 Sov PR Est Co FormДокумент6 страницDD Aia g702 g703 Sov PR Est Co Formbharat gadaraОценок пока нет
- Closing Costs NorwalkДокумент1 страницаClosing Costs NorwalkRufino AvilaОценок пока нет
- Certificate 1 - Mayrose SamynadenДокумент2 страницыCertificate 1 - Mayrose SamynadenDeepum HalloomanОценок пока нет
- Trial Balance Worksheet (MMMM DD, 200X) : General Ledger Account Balance Account Name Debit CreditДокумент3 страницыTrial Balance Worksheet (MMMM DD, 200X) : General Ledger Account Balance Account Name Debit CreditWhoОценок пока нет
- Construction Invoice Template - A4Документ2 страницыConstruction Invoice Template - A4Ali ogiОценок пока нет
- Courtney Downs June 06Документ54 страницыCourtney Downs June 06MarcyОценок пока нет
- Production Budget Initial Budgeted Actual In% In% In%Документ2 страницыProduction Budget Initial Budgeted Actual In% In% In%Anushka SinghОценок пока нет
- Usa Courtney Downs Leaseco, LLC Balance Sheet Books Accrual Feb 2008Документ58 страницUsa Courtney Downs Leaseco, LLC Balance Sheet Books Accrual Feb 2008MarcyОценок пока нет
- IC Contractor Estimate 9256Документ10 страницIC Contractor Estimate 9256nandiniapaya100% (1)
- RS 5haup9 20240105 FonДокумент2 страницыRS 5haup9 20240105 FonNature WonderОценок пока нет
- Acc 201 4Документ6 страницAcc 201 4Trickster TwelveОценок пока нет
- IC Contractor Estimate 57055 PTДокумент9 страницIC Contractor Estimate 57055 PTlorena.francaОценок пока нет
- Client Wise Portfolio Statement Client Code: BO ID: 1201630032610868 Name: Munira Akhtar As On: A/C Type: A/C StatusДокумент2 страницыClient Wise Portfolio Statement Client Code: BO ID: 1201630032610868 Name: Munira Akhtar As On: A/C Type: A/C StatusAbraham LinkonОценок пока нет
- Sales Invoice TemplateДокумент1 страницаSales Invoice TemplateM.Rizwan RafiqОценок пока нет
- RS 6ab254 20231006 FonДокумент2 страницыRS 6ab254 20231006 FonYatin ChawlaОценок пока нет
- Usa Courtney Downs Leaseco, LLC Balance Sheet Books Accrual Jan 2008Документ52 страницыUsa Courtney Downs Leaseco, LLC Balance Sheet Books Accrual Jan 2008MarcyОценок пока нет
- Balance Sheet As of December 2020: Jl. Semawung 26 OktoberДокумент1 страницаBalance Sheet As of December 2020: Jl. Semawung 26 Oktoberkhozimah nurОценок пока нет
- Essendon Project 3Документ4 страницыEssendon Project 3matthew.epark29Оценок пока нет
- Hensley, - Juan - Jaime SabinesДокумент2 страницыHensley, - Juan - Jaime SabinesJuan HensleyОценок пока нет
- Business Administration 636: Managerial Economics Homework Set #2 Dr. Adel ZaghaДокумент4 страницыBusiness Administration 636: Managerial Economics Homework Set #2 Dr. Adel ZaghaDana TahboubОценок пока нет
- Trial Balance December 2020: 10/26/2020 3:04:30 PM Account Debit Credit YTD Debit YTD CreditДокумент2 страницыTrial Balance December 2020: 10/26/2020 3:04:30 PM Account Debit Credit YTD Debit YTD Creditkhozimah nurОценок пока нет
- Numbers Sheet Name Numbers Table NameДокумент25 страницNumbers Sheet Name Numbers Table NameDARSH SADANI 131-19Оценок пока нет
- Latihan AKLДокумент4 страницыLatihan AKLMin RinОценок пока нет
- STMT BBGN 001 TNJN000012 Jul2023Документ9 страницSTMT BBGN 001 TNJN000012 Jul2023mascotreal7Оценок пока нет
- Far Activity LavadoДокумент14 страницFar Activity LavadoPamela AbenirОценок пока нет
- Accounts List SummaryДокумент3 страницыAccounts List SummaryPrabhani SarathchandraОценок пока нет
- IC Contractor Estimate 9256Документ9 страницIC Contractor Estimate 9256Loyd Carlo IbarraОценок пока нет
- AIA Application Certificate For Payment 1Документ7 страницAIA Application Certificate For Payment 1barnabasassefaОценок пока нет
- Sample Report ForДокумент14 страницSample Report ForNurnazihaОценок пока нет
- Courtney Down April 06Документ176 страницCourtney Down April 06MarcyОценок пока нет
- Contractor Project Cost Tracking Spreadsheet TemplateДокумент9 страницContractor Project Cost Tracking Spreadsheet TemplateBangОценок пока нет
- Unpaid Unclaimed Dividend Details For FY 2021-22 Special Interim Dividend PDFДокумент916 страницUnpaid Unclaimed Dividend Details For FY 2021-22 Special Interim Dividend PDFTumkur cctvОценок пока нет
- AFAR 2 NotesДокумент157 страницAFAR 2 NotesAlexandria EvangelistaОценок пока нет
- Shanta Securities LimitedДокумент1 страницаShanta Securities LimitedHabib UllahОценок пока нет
- Contractor EstimateДокумент8 страницContractor EstimateMirza Zahidul AlamОценок пока нет
- IC Construction Project Costing Tracking Spreadsheet 11369Документ9 страницIC Construction Project Costing Tracking Spreadsheet 11369Aron AhyaОценок пока нет
- Investment Property Income ExpensesДокумент25 страницInvestment Property Income ExpensesBenjamin Laughton-GoughОценок пока нет
- Usa Courtney Downs Leaseco, LLC Balance Sheet Books Accrual Dec 2007Документ58 страницUsa Courtney Downs Leaseco, LLC Balance Sheet Books Accrual Dec 2007MarcyОценок пока нет
- Trading Account FormatДокумент4 страницыTrading Account FormatCommerce Adda ConsultancyОценок пока нет
- Interim Payment Form No Dated:: ContractorДокумент4 страницыInterim Payment Form No Dated:: ContractorSenthilnathan NagarajanОценок пока нет
- Interim Payment Form No Dated:: ContractorДокумент4 страницыInterim Payment Form No Dated:: ContractorlearnafrenОценок пока нет
- Infosys Financial Balance Sheet Analysis PDFДокумент1 страницаInfosys Financial Balance Sheet Analysis PDFIshan AwastiОценок пока нет
- SES GH Induction Final 1Документ1 страницаSES GH Induction Final 1md. hasankamalОценок пока нет
- Apollo Shoes, Inc.: Prepared by Reviewed byДокумент3 страницыApollo Shoes, Inc.: Prepared by Reviewed byArista Yuliana SariОценок пока нет
- Trial BalanceДокумент1 страницаTrial BalanceKhozimah ZimahОценок пока нет
- 4087-4-29p-I5 (5 Files Merged)Документ5 страниц4087-4-29p-I5 (5 Files Merged)erferОценок пока нет
- AbdulhadiДокумент1 страницаAbdulhadikhaled khattapОценок пока нет
- Food Commodities Non-Food Commodities: Crs Commodity Loss and Claim Pursuit ReportДокумент1 страницаFood Commodities Non-Food Commodities: Crs Commodity Loss and Claim Pursuit ReportNikang Praises JamОценок пока нет
- JD Sdn. BHD Study CaseДокумент5 страницJD Sdn. BHD Study CaseSuperFlyFlyers100% (2)
- M 131162Документ3 страницыM 131162mahendrajadhav007mumbaiОценок пока нет
- Supplier VFH Template: Security Warning: Enable Macros Before Entering DataДокумент17 страницSupplier VFH Template: Security Warning: Enable Macros Before Entering DataEFREN JUAN DE LA CRUZ ARANGO HERRERAОценок пока нет
- IC Contractor Estimate 10806Документ9 страницIC Contractor Estimate 10806ahmed mostafaОценок пока нет
- NRSS 8 - Document Control Issue 4 1 FINALДокумент11 страницNRSS 8 - Document Control Issue 4 1 FINALtabaqui100% (1)
- 2 M.S Sequence Two Pictuary by Moudjib Arrahamane Khelil 2017-2018Документ8 страниц2 M.S Sequence Two Pictuary by Moudjib Arrahamane Khelil 2017-2018tabaquiОценок пока нет
- Turkey 130222070726 Phpapp02Документ20 страницTurkey 130222070726 Phpapp02tabaquiОценок пока нет
- Cps 0420 Project Incident ReportДокумент5 страницCps 0420 Project Incident ReporttabaquiОценок пока нет
- Cps 0405 Notice of Safety Non ComplianceДокумент1 страницаCps 0405 Notice of Safety Non CompliancetabaquiОценок пока нет
- Nom: Professeur: Date: Resultat:: Measure The Angle To The Nearest DegreeДокумент2 страницыNom: Professeur: Date: Resultat:: Measure The Angle To The Nearest DegreetabaquiОценок пока нет
- CP 0197 Professional Service Invoice FormДокумент10 страницCP 0197 Professional Service Invoice FormtabaquiОценок пока нет
- Pages de 126546663 HPPS Cleaning Flooding Hydrotest ProcedureДокумент1 страницаPages de 126546663 HPPS Cleaning Flooding Hydrotest ProceduretabaquiОценок пока нет
- Cps 0422 Witness StatementДокумент1 страницаCps 0422 Witness StatementtabaquiОценок пока нет
- Cps 0425 First Aid RegisterДокумент1 страницаCps 0425 First Aid RegistertabaquiОценок пока нет
- Pla 0011 B Letter of AssentДокумент1 страницаPla 0011 B Letter of AssenttabaquiОценок пока нет
- Cps 0460 Incident Notification ReportДокумент2 страницыCps 0460 Incident Notification ReporttabaquiОценок пока нет
- Project Management Tools Document MatrixДокумент35 страницProject Management Tools Document MatrixtabaquiОценок пока нет
- Des 0002 C Projectwise Upload Amp Validation Report CadДокумент1 страницаDes 0002 C Projectwise Upload Amp Validation Report CadtabaquiОценок пока нет
- CP 0540 Project Signage Safety Signage Instructions PackagaДокумент8 страницCP 0540 Project Signage Safety Signage Instructions PackagatabaquiОценок пока нет
- Select College: Los Angeles Community College DistrictДокумент4 страницыSelect College: Los Angeles Community College DistricttabaquiОценок пока нет
- Pa 0125 Letter of Organization LДокумент1 страницаPa 0125 Letter of Organization LtabaquiОценок пока нет
- Petro FacДокумент4 страницыPetro FactabaquiОценок пока нет
- Pma 0340 Schedule Baseline Change Request FormДокумент2 страницыPma 0340 Schedule Baseline Change Request FormtabaquiОценок пока нет
- Invoice Payment Check List: General ContractorДокумент2 страницыInvoice Payment Check List: General ContractortabaquiОценок пока нет
- CC 0140 Master File Index ListДокумент4 страницыCC 0140 Master File Index ListtabaquiОценок пока нет
- Des 0002 D Bim Asset Data For Design and As Built Documentation For New Cons PDFДокумент2 страницыDes 0002 D Bim Asset Data For Design and As Built Documentation For New Cons PDFtabaquiОценок пока нет
- CC 0140 Master File Index ListДокумент4 страницыCC 0140 Master File Index ListtabaquiОценок пока нет
- Harsh Environment Series Connection Systems 2014-05-05 PDFДокумент8 страницHarsh Environment Series Connection Systems 2014-05-05 PDFSicein SasОценок пока нет
- Heat Conduction Differential Equation of Heat Conduction: Rbitrarily SolidДокумент31 страницаHeat Conduction Differential Equation of Heat Conduction: Rbitrarily SolidJoshua StrykrОценок пока нет
- BS en 1096-3-2012 - (2022-08-18 - 04-11-32 Am)Документ22 страницыBS en 1096-3-2012 - (2022-08-18 - 04-11-32 Am)Free MouseОценок пока нет
- 2013 04Документ110 страниц2013 04Jose Emmanuel Martinez CordovaОценок пока нет
- ABB GOM 1ZSE 2750-108 en Rev 5 - Low ResДокумент16 страницABB GOM 1ZSE 2750-108 en Rev 5 - Low ResDimitar MarkovОценок пока нет
- BatteryДокумент3 страницыBatteryrtcaluyaОценок пока нет
- Fabric CuttingДокумент13 страницFabric CuttingShahjahanBadshaRony100% (1)
- EPRI Advances in Life AssessmentДокумент1 285 страницEPRI Advances in Life AssessmentPenjual AirОценок пока нет
- Energy, Work and Power: PHY111: Mechanics and Thermo Properties of MatterДокумент71 страницаEnergy, Work and Power: PHY111: Mechanics and Thermo Properties of MatterStudent 365Оценок пока нет
- Pipe - Line Bevel MachineДокумент24 страницыPipe - Line Bevel MachineSun SunОценок пока нет
- Chp15notes Part 2Документ32 страницыChp15notes Part 2api-255402590Оценок пока нет
- Solution of The Graetz-Brinkman Problem With The Laplace Transform Galerkin MethodДокумент9 страницSolution of The Graetz-Brinkman Problem With The Laplace Transform Galerkin MethodDeny Arief RusamsiОценок пока нет
- Brake Squeal Virtual Design PDFДокумент7 страницBrake Squeal Virtual Design PDFeng13Оценок пока нет
- Establish A New Commercial BankДокумент60 страницEstablish A New Commercial Bankmamun322Оценок пока нет
- Continuously Variable Transmission - CVTДокумент18 страницContinuously Variable Transmission - CVTPratheep Srinivas100% (3)
- Simbologia PDFДокумент1 страницаSimbologia PDFMartin Abraham Perez UriasОценок пока нет
- KP-00+++-MQ758-V0010-Rev 0-MS For CB Installation Works PDFДокумент27 страницKP-00+++-MQ758-V0010-Rev 0-MS For CB Installation Works PDFUtku Can Kılıç100% (1)
- Renewable and Sustainable Energy Reviews: MD Maruf Hossain, Mohd. Hasan AliДокумент9 страницRenewable and Sustainable Energy Reviews: MD Maruf Hossain, Mohd. Hasan AliJuan MОценок пока нет
- Engg CW DetailsДокумент26 страницEngg CW DetailsMuhammad Sohail TariqОценок пока нет
- Glossary of Heat Exchanger TerminologyДокумент2 страницыGlossary of Heat Exchanger Terminologypvwander100% (1)
- Boletin 6019 - Descontinuar SC-NДокумент2 страницыBoletin 6019 - Descontinuar SC-NPau MundacaОценок пока нет
- ML023030334 Risk ManagementДокумент157 страницML023030334 Risk ManagementMutahirrasoolОценок пока нет
- SCERT Kerala State Syllabus 9th Standard Physics Textbooks English Medium Part 2Документ64 страницыSCERT Kerala State Syllabus 9th Standard Physics Textbooks English Medium Part 2SafarОценок пока нет
- 1st Yr Lec3Документ16 страниц1st Yr Lec3abhijeetnarkhede69198Оценок пока нет
- Leroy Somer D510C AVRДокумент54 страницыLeroy Somer D510C AVRabuzer1981Оценок пока нет
- Chapter 2 - Open ChannelДокумент51 страницаChapter 2 - Open Channeladeliene 25Оценок пока нет
- 1 Introduction and Mathematical ConceptsДокумент13 страниц1 Introduction and Mathematical ConceptsKim CastilloОценок пока нет
- Engine Variable On Flame PropagationДокумент10 страницEngine Variable On Flame PropagationDebarpan SahaОценок пока нет
- Name .. Tutor .: Carbohydrate & Water Test (/50)Документ4 страницыName .. Tutor .: Carbohydrate & Water Test (/50)NecrOtic ObsessionОценок пока нет
- Egev ProhsДокумент2 страницыEgev ProhsOscar Campos TarazonaОценок пока нет
