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TO: FROM: SUBJECT:

Job No. FAP No. Job Name Date Arkansas Highway and Transportation Department, Little Rock, Arkansas

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

Under the provisions of The Arkansas Highway Commission Contract, request for advance payment is hereby 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 unpaid invoice.

1 . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

@ __________ @ ___________

It is understood that the minimum individual payment for stored materials as provided herein shall be not less than $50,000.00.

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) in the sum of $ payable to the ______________ Contractor by the Arkansas Highway and Transportation Department for materials not yet incorporated into the work, as described above. The Contractor hereby agrees to tender payment in full in the sum of

$

______________

to the Supplier

,

__________________________________

,

within 10 calendar days

from receipt of payment by the Department. In the event payment in full is not made by the Contractor to the Supplier within said 10 calendar days, the Surety acknowledges and agrees to responsibility for

payment in full to the Supplier in the sum of $

______________

under the Statutory Payment Bond.

The Contractor shall provide the Department a paid invoice within ten (10) calendar days after the payment to the Supplier.

Surety

By:

Licensed Agent (Seal)

Supplier

Contractor

By:

By:

Authorized Agent

Authorized Agent

Figure 109-2A

Rev. 2-16-04

Page 100-128

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