Monthly Payments To Subcontractors/suppliers -
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3MONTHLY PAYMENTS TO SUBCONTRACTORS/SUPPLIERS – FORM B
The following form has been designed to track Contractor’s commitments and actual monthly payments to subcontractors/suppliers on a City project. The
form has been formatted to allow the Contractor’s representatives to print or type in the requested information. (Typing is preferred.)
Note: An electronic version that can be typed into will be posted on
Submit this form with your company’s monthly invoices for payment for work by your company on the City contract.
Contract Number#: List the project’s assigned contract number if it is not already listed.
Project Name: List the official name of the project if it does not already appear.
Contractor Name: List your company’s name.
Non-DBE or DBE Contractor: Check whether your company (as the contractor) is a DBE certified firm.
Reporting Month/Year: Identify the month of the transactions that is being reported.
Dollars Paid to Contractor: Identify all payments that have been made to your company from this contract since the notice to proceed.
List all Subcontractors, Subconsultants, and Material Suppliers that have worked and/or that your company intends to use on the project.
Note: the “” check box column is for City staff use only.
Total Dollars
Dollars Paid this
Total Dollars Paid
Company, Contact Person, Email and Phone.
Work performed or materials provided
√
Commitment
Month
since NTP
Company, Contact Person, Email and Phone: List the subcontractor/supplier companies’ names, contact persons, email addresses and phone numbers.
Work performed or materials provided: Identify what type of work or materials that were supplied by the subcontractor/supplier companies.
Total Dollars Commitment: Identify the company’s total project estimated dollar commitment to the subcontractor/supplier companies.
Dollars Paid this Month: List the total amount of actual payments made to each subcontractor/supplier company in the reporting month listed.
Total Dollars Paid since NTP: List the total amount of actual payments made to the subcontractor/supplier company since the Notice to Proceed.
That official authorized and responsible for certifying payments listed on the form should:
Print his or her name and title.
Type or print the phone number of the representative responsible for certifying subcontractor payments.
Sign and date the form in the presence of a notary. Have the notary certify the representative’s signature.
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Parent category: Business