Form 39-2 - Contractor'S Payment Summary - Nyc Parks printable pdf download

Contractor’s Payment Summary

Form 39-2

Change Order Work Only

PAYMENT NO. _______________________

a. Total Cost of Change Order Work to Date

$________________(a)

b. Retained Percentage* for Change Order Work

$________________(b)

c. Total Change Order Work Previously Certified

$________________(c)

d. Net Amount due this estimate (a-b-c)

$________________(d)

e. Less Amount withheld, Reason_________________________

$________________(e)

Payment

$________________(d&e)

*Partial = 5%, Substantial Completion and Final = 1%

Final = 0%, if guarantee release accompanies payment.

CONTRACTOR'S CERTIFICATE

I (we) certify that all items, units, quantities and prices of work and material shown on this estimate are correct;

that all work has been performed and material supplied in full accordance with the terms and conditions of the

contract between the Department of Parks and Recreation of the City of New York,

I (we)__________________ (Contractor) and all authorized change(s) thereto; that all contract provisions relating

to prevailing wages have been complied with; that all outstanding claims for labor, materials and equipment for

the performance of said contract except the outstanding claims listed in the attached sheet, "Certificate of

Contractor to the Comptroller" and as listed below; that the above is true and correct statement of the contract

account up to and including the last day of the period covered by this estimate and that no part of the "payment

due this estimate" has been received.

Furthermore, in compliance with Article 35 Section 6 and Article 36 of the Agreement, I (we) certify that

I (we) have complied with Section 6-108 of the New York City Administrative Code relating non discrimination

provisions of Section 220e of the New York State Labor Law and with Section 6-108 of the New York City

Administrative Code and subsequently, enacted, rules and regulations or amendments thereto relating to

minimum wage.

Contractor’s Signature______________________________________ Date_______________________

Title________________________

Contractor’s Company Name________________________________

RESIDENT ENGINEER’S CERTIFICATE

I certify that I have verified this estimate and that to the best of my knowledge and belief it is a true and correct

statement of the work performed and materials supplied by the contractor, and that all work and material included

in this estimate have been inspected by me or my duly authorized assistants and have found to comply with the

terms and conditions of the corresponding construction contract documents and authorized changes thereto. I

further certify that I have verified that certificates of non-discrimination have been obtained from the contractor

and all sub-contractors who performed any work covered by this payment.

Resident Engineer______________________________

Date______________________________

Submit Form To: Borough Director, Resident Engineer

Revised: 7/15

Form 39-2 - Contractor'S Payment Summary - Nyc Parks

Related Articles

Related forms

Related Categories