Sample Architect'S Statement For Services
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1ABC Form B-5 (State)
July 2006
SAMPLE ARCHITECT’S STATEMENT FOR SERVICES
ARCHITECT’S NAME and ADDRESS or LETTERHEAD
(Federal employer’s identification number on each copy)
To:
Owner (Local Owner)
Address
Project:
B.C.No. __________________
Date:
PSCA No. ________________
Statement for Architectural Services Rendered as Follows:
1. Basic Fee: ( ______ % or Lump Sum $_____________)
Amount of Construction Contract: $ _______________
Service A: 10% X _____% X Amount of Contract
$ __________________
Service B: 15% X _____% X Amount of Contract
$ __________________
Service C: 50% X _____% X Amount of Contract
$ __________________
Service D:
5% X _____% X Amount of Contract
$ __________________
Service E: 20% X _____% X Amount of Contract X ______% Complete
$ __________________
Total Basic Fee Earned to Date
$ __________________
2. Other Fees Per Special Provisions of the Agreement:
(Fully account for Other Fees here or in an attachment)
Amount included in Previous Billings
$ __________________
Increase for this Billing
$ __________________
Total Other Fees Earned to Date
$ __________________
3. Reimbursable Expenses:
(Fully account for Reimbursable Expenses here or in an attachment)
Amount included in Previous Billings
$ __________________
Increase for this Billing
$___________________
Total Reimbursable Expenses Incurred to Date
$ __________________
4. Total Amount Earned To Date
$ __________________
5. Less Previous Invoices
$ __________________
6. Amount Due This Invoice
$ __________________
I certify that the above account is correct, just and that payment therefor has not yet been received.
Sworn to and subscribed before me
this _______ day of _______________
(Architect)
____________________________ L.S.
By __________________________________________
___________________________________________
(Title)
APPROVALS:
The Awarding Authority certifies that funds are available in the amount required for this invoice.
Approved by
_________________________________________________
Date __________________
Signature
_________________________________________________
Name of Local Owner
Approved by
_________________________________________________
Date __________________
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