Form 39-1 - Contractor'S Payment Summary - Nyc Parks printable pdf download

Contractor’s Payment Summary – Contract Work Only

Form 39-1

PAYMENT NO: ________________

a. Cost of Contract Work to Date

(a)

b. Amount Due for Stored Material

(b)

c. Total Amount to Date (a + b)

(c)

d. Retained Percentage* for Contract Work Only

(d)

e. Total Contract Work Previously Certified

(e)

f. Liquidated Damages

(f)

g. Net Amount due this estimate (c-d-e-f)

(g)

h. Less Amount Withheld, Reason: _______________________

(h)

i. Payment Due this Estimate

(g–h)

*Partial = 5%, Substantial completion = 1% + 2 x P.L., 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

Department of Parks and Recreation of the City of New York and ______________(Contractor) dated __________ and all

authorized change 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. The following is a true and correct list of all subcontractors

who have employed laborers and/or used material and/or supplies for work performed under said contract. Furthermore in

compliance with Article 35, Section 6 of the Agreement, I (we) certify that I (we) have complied with Section 6-108 of the

New York City Administrative Code relating to non-discrimination, with the 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.

SUBCONTRACTOR'S NAME

TRADE

VALUE PREVIOUSLY PAID

VALUE THIS REQUEST

REFER TO ATTACHED FORM 44 – SUBCONTRACTOR COMPLIANCE REPORT

__________________________

Contractor's Signature

Date

Agency Contract No.

________________________________________________

Title

Contractor 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 subcontractors who performed any work

covered by this payment.

Contract Time

CC Days

Percent of Work Completed ______________ %

Total Time Consumed to Date ____________ Days

Percent of Time Elapsed _________________%

Resident Engineer Signature: ___________________________

Date: _________________________________

Resident Engineer Printed Name: __________________________

R.E. Phone Number: ______________________

Submit Form To: Borough Director, Resident Engineer, Data Systems

Revised GB: 7/15

Form 39-1 - Contractor'S Payment Summary - Nyc Parks

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