Prompt Payment Certification And Supporting …

1 Prompt Payment Certification And Supporting DataFor Contractor Payment Invoice(1)Contract No.:(2)Location and Description of Work:(3)Estimate No.:(4)Invoice Date:(5)Contractor Official (name and address) to whom Payment is(6)Discount Terms:to be sent:(7)If Notice of Assignment has been filed, enter name of(8)Name, Title, phone number, and mailing address of person to be notified inAssignee to whom Payment is to be sent:event of a defective invoice:(9)(10)(11)(12)(13) **Subcontractor NameTotal AmountPrevious SubcontractorSubcontractorSubcontractor EarningsSubcontractedPaymentsAmount Included in thisDeducted by Contractor(Excluding Deductions) Payment Estimate(Total to Date)(Excluding Deductions)**A written notice of any withholding shall be issued to a subcontractor (with a copy to the Contracting Officer) of any such notice issued by the Contractor,specifying (1) the amount to be withheld, (2) the specific causes for the withholding under the terms of the subcontract, and (3) the remedial actions to betaken by the subcontractor in order to receive Payment of the amounts withheld.

2 Attach copy of notification to pay estimate. Reference FAR (g).I herby certify, to the best of my knowledge and belief, that:(1)The amounts requested are only for performance in accordance with the specifications, terms, and conditions of the contract;(2) payments to subcontractors and suppliers have been made from previous payments received under the contract, and timely payments will bemade from the proceeds of the payments covered by this Certification , in accordance with subcontract agreements and the requirements ofChapter 39 of Title 31, United States, Code; and(3)This request for progress payments does not include any amounts which the prime contractor intends to withhold or retain from a subcontractoror supplier in accordance with the terms and conditions of the subcontract.

3 (4)This Certification is not to be construed as final acceptance of a subcontractor's Name and TitleW912PP-07-C-0010 NAKayenta, ArizonaRMS Training Contract2603/16/2010 Freeman's Funny Farm1895 North Fork RoadSeattle WA 985000 Days0 PercentAero Automatic Sprinkler Co.$430, $376, $5, $5, Construction Co$ $ $ $ Fire & Safety$5, $5, $ $ Fence$153, $121, $ $ Custom Millwork$202, $197, $2, $ , Inc.$122, $122, $ $ Enterprises, Inc; DBA: Tucson Restaurant Equipment &$ $ $ $ of Indian Aff$ $ $ $ of Indian Affairs$ $ $ $ Court Constr$70, $5, $1, $ Products & Equipment$25, $18, $ $ Enterprises$2,188, $2,038, $ $ Structures, Inc$2,864, $2,738, $ $ Decor, Inc.

4 $12, $ $ $ Slab - Albuquer$103, $103, $ $ Albritton, Project ManagerPage 1 of 29 pagesPrompt Payment Certification And Supporting DataFor Contractor Payment Invoice(1)Contract No.:(2)Location and Description of Work:(3)Estimate No.:(4)Invoice Date:(9)(10)(11)(12)(13) **Subcontractor NameTotal AmountPrevious SubcontractorSubcontractorSubcontractor EarningsSubcontractedPaymentsAmount Included in thisDeducted by Contractor(Excluding Deductions) Payment Estimate(Total to Date)(Excluding Deductions)W912PP-07-C-0010 NAKayenta, ArizonaRMS Training Contract2603/16/2010 Coreslab Structures - PHX$58, $58, $ $ Metro PHX$5, $5, $ $ Mechanical$1,363, $1,267, $ $ Systems$49, $49, $ $ Contracting$24, $ $ $ Pump$115, $ $ $ Constructors, In$ $ $ $ Redmond and As$332, $79, $ $ & G Enterprises$973, $973, $ $ Drilling$543, $540, $ $ Electrical$2,978, $2,525, $ $ , Inc.

5 $120, $92, $ $ , Inc.$1, $1, $ $ Industries, Inc.$12, $9, $ $ Architectural Signage$37, $ $ $ Tile, Inc.$345, $132, $ $ Bolander & Sons$2, $2, $ $ & K Mechanical$1,833, $1,769, $ $ & Associates$9, $9, $ $ $126, $ $ $ Gas Technologies$66, $66, $ $ Industries$37, $31, $ $ Surveying$142, $127, $ $ Elevator$140, $122, $ $ & Accessories$132, $ $ $ Pest Control$22, $22, $ $ Acoustics$174, $ $ $ Fabricators, Inc.$540, $540, $ $ Line Technolog$ $ $ $ Roofing$929, $787, $ $ E. Nelson$3,578, $3,559, $ $ Building Syste$239, $239, $ $ Cohen Co., LL$78, $58, $ $ Paving$403, $403, $ $ & H Steel$1,310, $1,290, $ $ Juan Glass$484, $457, $ $ Design Concepts$54, $54, $ $ Dor of Phoenix$221, $190, $ $ Installations, Inc.

6 $ $ $ $ Technology, Inc.$33, $ $ $ Construction$188, $188, $ $ 2 of 29 pagesPrompt Payment Certification And Supporting DataFor Contractor Payment Invoice(1)Contract No.:(2)Location and Description of Work:(3)Estimate No.:(4)Invoice Date:(9)(10)(11)(12)(13) **Subcontractor NameTotal AmountPrevious SubcontractorSubcontractorSubcontractor EarningsSubcontractedPaymentsAmount Included in thisDeducted by Contractor(Excluding Deductions) Payment Estimate(Total to Date)(Excluding Deductions)W912PP-07-C-0010 NAKayenta, ArizonaRMS Training Contract2603/16/2010 USACE$ $ $ $ International LL$56, $ $ $ Technologies$ $ $ $ Floors$458, $353, $ $ $24,410, $21,744, $9, $5, 3 of 29 pagesContractor Requested Earnings(1)Contract No.

7 :(2)Location and Description of Work:(3)Estimate No.:(4)Invoice Date:ActivityActivityActivityTotal Previous% EarningTotal DateTo DateThis PeriodW912PP-07-C-0010 NAKayenta, ArizonaRMS Training Contract2603/16/2010 CCKS1000 Change Order No. 1 FFE for COR$2, $2, $2, $ order - Ref: RFP-0009 I$1, $1, $1, $ order - Ref: RFP-0009 I$20, $20, $20, $ Order - Ref: RFP-0009 I$ $ $ $ Order - Ref: RFP-0009 I$5, $5, $5, $ Order - Ref: RFP-0005 -$106, $106, $106, $ Order - RFP-0002 Rock E$91, $91, $91, $ Order - RFP-0010 - Tras$9, $9, $9, $ Order - RFP-0010 - Tras$3, $3, $3, $ Order - RFP-0010-Trash$9, $9, $9, $ Order- RFP-0010 - Trash$2, $2, $2, $ Order - RFP-0012 - Comm$32, $32, $32, $ Order - R-00015 / A0018$55, $55, $55, $ Order - R-00015 / A0018$1, $1, $1, $ Order - R-00015 / A0018$6, $6, $6, $ Line/Water Line Conflict$13, $13, $13, $ Order - R00021/A0009 -$7, $7, $7, $ Order - R00021/A0009 -$2, $2, $2, $ Order - R0022 / A0021 P$96, $4, $4, $ Perimeter Fence$3, $3, $3, $ E Nelson - Move-In$6, $6, $6, $ for Perimeter Fence / La$36, $36, $36.

8 $ Perimeter Fence$19, $19, $19, $ for Temporary Power Off$2, $2, $2, $ for Temporary Power - J$3, $3, $3, $ Temporary Power Office$6, $6, $6, $ Temporary Power to Job$11, $11, $11, $ & Grub Site$45, $45, $45, $ / Compaction Testing$56, $56, $56, $ Sub-Grade Prepreation$169, $169, $169, $ School Sub Grade$5, $5, $5, $ / Process Fill Southwes$120, $120, $120, $ / Process Fill Northwes$317, $317, $317, $ / Process Fill Northeas$239, $239, $239, $ / Process Fill Southeas$205, $205, $205, $ School Subgrade$6, $6, $6, $ Backstop - East$3, $3, $3, $ Backstop - West$3, $3, $3, $ Dormitory Subgrade$5, $5, $5, $ / Process Fill South Wi$154, $154, $154, $ / Process Fill North Wi$102, $102, $102, $ Dormatory Subgrade$7, $7, $7, $ Storm Channel$6, $6, $6, $ 4 of 29 pagesContractor Requested Earnings(1)Contract No.

9 :(2)Location and Description of Work:(3)Estimate No.:(4)Invoice Date:ActivityActivityActivityTotal Previous% EarningTotal DateTo DateThis PeriodW912PP-07-C-0010 NAKayenta, ArizonaRMS Training Contract2603/16/2010 FGKS1160 Excavate Storm Channel$90, $90, $90, $ / Process Site Fill Sou$345, $345, $345, $ / Process Site Fill Nor$475, $475, $475, $ / Process Site Fill Sou$450, $450, $450, $ / Process Site Fill Nor$514, $514, $514, $ for Site Fill$3, $3, $3, $ / Process Site Fill No$6, $6, $6, $ / Process Site Fill So$6, $6, $6, $ / Process Site Fill So$6, $6, $6, $ / Process SIte Fill No$6, $6, $6, $ / Move in Office$120, $120, $120, $ Perimeter Fence, Eauipm$3, $3, $3, $ Chain Link Perimeter F$127.

10 $120, $120, $ Overflow Parking Grave$10, $10, $10, $ Surface - Sheet C105$6, $6, $6, $ Flag Poles$2, $2, $2, $ Bike Rack at School Bu$4, $4, $4, $ Rip-Rap at Storm Drain H$ $ $ $ Rip-Rap at South Side of$ $ $ $ Rip-Rap at North West$ $ $ $ Bike Rack at Domitory$4, $4, $4, $ Gravel Surface at New$1, $1, $1, $ Propane Tank$8, $8, $8, $ Cantiliver Rolling Gat$29, $28, $28, $ Striping$2, $2, $2, $ Site Light Poles$11, $11, $11, $ play ground$3, $3, $3, $ Basketball Goals$ $ $ $ Asphalt Paving at Stati$6, $6, $6, $ Curb and Gutter$6, $6, $6, $ Sub-Grade$1, $1, $1, $ Road to Sub- Grade$26, $26, $26, $ 6" Sub-Grade Compactio$12, $12, $12, $ old school road subgra$3, $3, $3, $ Geogrid Soil Reinforce$ $ $ $ 6" Sub-Base Placement$25, $25, $25, $ AB$25, $25, $25, $ old school road AB$3, $3, $3, $ / Form / Place Concre$20, $20, $20, $ / Form / Place Concre$37, $37, $37, $ / Form / Place Concre$44, $44, $44, $ / Place Wheel Chair Ramps$12, $12, $12, $ Asphalt Prime Coat at$5, $5, $5, $ 5 of 29 pagesContractor Requested Earnings(1)Contract No.