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Client Name ??????

Contractor's Payment Certificate


Interim Advance Payment Interim Progress Payment Interim Exchange of Retention

Final Pay and Release of Retention

CONTRACT NO.: Contractor's Payment Certificate No.:


CONSULTANT Certificate Date:
CONTRACTOR Valuation Date :
PROJECT TITLE

Original Contract Value $


Provisional Sums $
Approved Omission Variation Orders $
Approved Addition Variation Orders $

Revised Contract Value $

CUMULATIVE CUMULATIVE THIS PAYMENT


To Date (SR) previous (SR) (SR)

Executed Against Original Contract


Value of Works executed against Lump Sum Break Down of $
Value of Works executed against Provisional Sums
Material on site
Sub total

Gross Certified Against Original Contract

Executed Against Change Orders


Value of Works executed against Change Order

TOTAL GROSS CERTIFIED

RETENTION RETAINED
RELEASED

TOTAL NET CERTIFIED

ADVANCE PAYMENT
ADVANCE PAYMENT RECOVERY

Deductions, Penalties and / or other Adjustments


On Hold

Total Deductions / On Hold Amounts

AMOUNT CERTIFIED THIS PAYMENT CERTIFICATE

Submitted by Contractor: Stamp:

Project Manager
Reviewed by Engineer: Stamp:

Resident Engineer
Certified for Payment by Program Manager:

Project Manager Commercial Manager Project Executive


Approved for Payment by Client:

Engineering Dept. Manager Client - General Manager

IPC R.00

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