Personal Service Contract Invoice Form

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PERSONAL SERVICE CONTRACT INVOICE FORM
GOVERNMENT CONTRACT REVIEW COMMITTEE
LEGISLATIVE RESEARCH COMMISSION
Pursuant to KRS 45A.695, no payment shall be made on any personal service contract unless
the individual, firm, partnership, or corporation awarded the personal service contract submits its
invoice for payment on a form established by the committee.
Invoices shall be submitted every ninety (90) days, unless the personal service contract specifies a
different submission time period.
Separate invoices shall be submitted for each distinct matter covered by the personal service
contract, and shall be signed by the individual responsible for that matter
The issuance of an invoice to the Commonwealth constitutes an affirmation by the
individual, firm, partnership, or corporation awarded the personal service contract that the
invoice truly and accurately represents work actually performed, and the expenses actually
incurred.
The head of the contracting body shall approve the invoice, indicating that the charges in the
invoice reflect the value of the work performed, and all recorded costs and disbursements were
reasonably and necessarily incurred in connection with the matter invoiced.
NOTE: All questions must be answered fully. If the space provided is insufficient,
additional pages should be attached referencing the specifically numbered item. Any
questions regarding the invoice requirements should be directed to the contracting agency.
Contract Number:______________________ Date of Invoice:________________
___________________________________
_________________________________
Contracting Body
Division, Branch, etc.
1. Name & Address of Contractor:
2. Contractor’s Tax I.D. Number:_______________
3. Effective Period of Contract:
4. Combined Total Amount Charged in this
Starting Date: _____________
Invoice for Services and Reimburseable
Ending Date: _____________
Disbursements:___________________
5. Dates of Service Covered under
6. Is this the FINAL invoice
this invoice:
for services performed
Starting Date:_____________
under this contract:
Ending Date: _____________
_____ Yes ______ No
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