Transcription of Payment Certificate Certificate No - JBCC
1 Payment Certificateissued in terms of of thePrincipal Building Agreement Certificate No(Interim or Final)Employer ContractorWorks Site Valuation date:A CONTRACTSUMBCURRENTCONTRACT VALUECCURRENTVALUATIONDCURRENTCERTIFICAT IONP ayment due of work executed [ ] on site [ ] off site [ ] adjustment [ , ](yes/no)(If Yes)% contract to contract value [ ] price adjustment [ ] AMOUNT gross amount certified [ , ] AMOUNT and Loss [Recovery Statement ] Penalties [Recovery Statement ] Damages [Recovery Statement ] on [ , ] / Advance Payment Recoupment [Recovery Statement ] Interest / Advance Payment Made [Recovery Statement ] AMOUNT DUE FOR Payment TO THE (Contractor /Employer) sum execution % [Variable construction guarantee only]( x 100) %Security status (Mark each box with a U or Y) < 50% > 50%Practical completion Final completionSigned by the principal agent who, as agent for the employer, certifies that thepositive or negative amount stated in above is due and payable Signed:Date:Name of firm: jbcc Series 2000 Code 2142 August 2007
