Fillable Form 1443 - Contractor'S Request For Progress Payment printable pdf download

OMB Number 9000-0010

CONTRACTOR'S REQUEST FOR PROGRESS PAYMENT

Expires: 5/31/2012

IMPORTANT: This form is to be completed in accordance with instructions on the reverse.

SECTION I - IDENTIFICATION INFORMATION

1. TO: NAME AND ADDRESS OF CONTRACTING OFFICE ADMINISTERING THE

2. FROM: NAME AND ADDRESS OF CONTRACTOR (Include ZIP Code)

CONTRACT (Include ZIP Code)

4. CONTRACT NUMBER

3. SMALL BUSINESS

A. BASIC CONTRACT NUMBER

PAYING OFFICE

B. TASK OR DELIVERY ORDER NUMBER

YES

5. CONTRACT PRICE

6. RATES

8A. PROGRESS PAYMENT REQUEST NUMBER 8B. DATE OF THIS REQUEST

7. DATE OF INITIAL AWARD

A. PROGRESS PAYMENTS

B. LIQUIDATION

A. YEAR

B. MONTH

SECTION II - STATEMENT OF COSTS UNDER THIS CONTRACT THROUGH

(Date)

9. RESERVED

10. RESERVED

11. COSTS ELIGIBLE FOR PROGRESS PAYMENTS UNDER THE PROGRESS PAYMENTS CLAUSE

12a. TOTAL CONTRACT COST(S) INCURRED TO DATE

b. ESTIMATED COST TO COMPLETE

c. TOTAL ESTIMATED COST OF PERFORMANCE

13. ITEM 11 MULTIPLIED BY ITEM 6a

14a. FINANCING PAYMENTS PAID TO SUBCONTRACTORS

b. LIQUIDATED FINANCING PAYMENTS TO SUBCONTRACTORS

c. UNLIQUIDATED FINANCING PAYMENTS PAID TO SUBCONTRACTORS (Item 14a less 14b)

d. SUBCONTRACT FINANCING PAYMENTS APPROVED FOR CURRENT PAYMENT

e. ELIGIBLE SUBCONTRACTOR FINANCING PAYMENTS (Item 14c plus 14d)

15. TOTAL DOLLAR AMOUNT (Item 13 plus 14e)

16. ITEM 5 MULTIPLIED BY ITEM 6b

17. LESSER OF ITEM 15 OR ITEM 16

18. TOTAL AMOUNT OF PREVIOUS PROGRESS PAYMENTS REQUESTED

19. MAXIMUM BALANCE ELIGIBLE FOR PROGRESS PAYMENTS (Item 17 less 18)

SECTION III - COMPUTATION OF LIMITS FOR OUTSTANDING PROGRESS PAYMENTS

20. COMPUTATION OF PROGRESS PAYMENT CLAUSE LIMITATION

a. COSTS INCLUDED IN ITEM 11, APPLICABLE TO ITEMS DELIVERED, INVOICED, AND

ACCEPTED TO THE DATE IN HEADING OF SECTION II

b. COSTS ELIGIBLE FOR PROGRESS PAYMENTS, APPLICABLE TO UNDELIVERED ITEMS AND

TO DELIVERED ITEMS NOT INVOICED AND ACCEPTED (Item 11 less 20a)

c. ITEM 20b MULTIPLIED BY ITEM 6a

d. ELIGIBLE SUBCONTRACTOR FINANCING PAYMENTS (Same as Item 14e)

e. LIMITATION (Item 20c plus 20d)

21. COMPUTATION OF PROGRESS PAYMENT CLAUSE LIMITATION

a. CONTRACT PRICE OF ITEMS DELIVERED, ACCEPTED AND INVOICED AS OF THE DATE SHOWN

IN THE HEADING OF SECTION II

b. CONTRACT PRICE OF ITEMS NOT DELIVERED, ACCEPTED AND INVOICED (Item 5 less 21a)

c. ITEM 21b MULTIPLIED BY ITEM 6b

d. UNLIQUIDATED ADVANCE PAYMENTS PLUS ACCRUED INTEREST

e. LIMITATION (Item 21c less 21d)

22. MAXIMUM UNLIQUIDATED PROGRESS PAYMENTS (Lesser of Item 20e or 21e)

23. TOTAL AMOUNT LIQUIDATED AND TO BE LIQUIDATED

24. UNLIQUIDATED PROGRESS PAYMENTS (Item 18 less 23)

25. MAXIMUM PERMISSIBLE PROGRESS PAYMENTS (Item 22 less 24)

26. AMOUNT OF CURRENT INVOICE FOR PROGRESS PAYMENT (Lesser of item 25 or 19)

27. AMOUNT APPROVED BY CONTRACTING OFFICER

CERTIFICATION

DATE

I Certify that:

(a) The above statement (with attachments) has been prepared from the books and records of the above-named contractor in accordance with the contract and the instructions

hereon, and to the best of my knowledge and belief, that it is correct;

(b) All the costs of contract performance (except as herewith reported in writing) have been paid to the extent shown herein, or where not shown as paid have been paid or will be

paid currently, by the contractor, when due, in the ordinary course of business;

(d) The quantities and amounts involved are consistent with the requirements of the contract;

(e) There are no encumbrances (except as reported in writing herewith, or on previous progress payment request number

) against the property acquired

or produced for, and allocated or properly chargeable to the contract which would affect or impair the Government's title;

(f) There has been no materially adverse change in the financial condition of the contractor since the contractor's (insert 'as of' date of financial information)

submission of its last financial information dated (insert date of prior submission/certification)

to the Government in connection with the contract;

(g) To the extent of any contract provision limiting progress payments pending first article approval, such provision has been complied with, and

(h) After the making of the requested progress payment the unliquidated progress payments will not exceed the maximum unliquidated progress payments permitted by the contract.

NAME AND TITLE OF CONTRACTOR REPRESENTATIVE SIGNING THIS FORM

SIGNATURE

NAME AND TITLE OF CONTRACTING OFFICER

SIGNATURE

STANDARD FORM 1443 (REV. 7/2009)

Prescribed by GSA FAR (48 CFR 53.232)