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2003 SPECIFICATIONS

SECTION 109

Job No.

FAP No. Job Name Date

TO: FROM: SUBJECT:

Arkansas Highway and Transportation Department, Little Rock, Arkansas

Request for Advance Payment for Stored or Stockpiled Materials Under Paid Invoice

Under the provisions of The Arkansas Highway Commission Contract, request is made for payment of Material Estimates for materials as listed, produced or delivered for use on

Job , and stored in an acceptable manner. These advance payments are requested at ____________ invoice prices or agreed unit prices based upon actual cost of reproduction. The Contractor has submitted the attached paid invoice.

1. 2.

______________________________ ______________________________

@___________ @ ___________

It is understood that the minimum individual payment for stored materials as provided herein shall be not less than $20,000.00.

The Contractor hereby certifies that the material meets the requirements of the Specifications for the stage of production at which the material is stored.

The Contractor undertakes to safeguard the materials on which advance payments have been made and to deliver such materials to the work in the proper sequence of construction. It is understood that amounts advanced on stored or stockpiled materials will be recovered by the State through deductions made on construction estimates as the materials are incorporated into the work.

The Surety Company consents to payment(s) to the Contractor by the Arkansas Highway and Transportation Department for materials not yet incorporated into the work, as described above.

Surety

Contractor

By: Licensed Agent

By:

Authorized Agent

(Seal)

FIGURE 109-2

Page 100-127

Rev. 2-16-04

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