FORM 18303

Page 1 of 3

APPLICATION FOR PAYMENT ON CONTRACT

(Submit in Triplicate - Attach a breakdown of cost and supporting
documentation as required)

+---------------------------------+---------------------+--------------+
| TO: PACIFIC NORTHWEST NATIONAL  | CONTRACT NO.        | Task         |
|                                 | \_\_\_\_\_\_\_\_    |              |
| LABORATORY                      |                     | Order No.    |
|                                 |                     | \_           |
| BATTELLE MEMORIAL INSTITUTE     |                     | \_\_\_\_\_\_ |
|                                 |                     |              |
| P.O. BOX 999                    |                     |              |
|                                 |                     |              |
| RICHLAND, WA 99352              |                     |              |
+---------------------------------+---------------------+--------------+
|                                 | APPLICATION NO.     | Date         |
|                                 | \_\_\_\_\_          | \_\_\_\_\_   |
|                                 |                     | \_\_\_\_\_\_ |
+---------------------------------+---------------------+--------------+
|                                 | COVERING PERIOD     |              |
|                                 | \_\_\_\_\_\_\_\_\_  |              |
|                                 | to                  |              |
|                                 | \_\_\_\_\_\_\_\_\_  |              |
+---------------------------------+---------------------+--------------+

ATTN: ACCOUNTS PAYABLE

Application is hereby made for payment of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ dollars
(which is the net amount shown below) on account of work performed under
the above contract. Invoice and supporting documentation, as required
(i.e., delineation of lower-tier procurements, travel, overtime and
other charges), is attached.

+--------------------------------+-------------------------------------+
| Contractor                     |                                     |
+--------------------------------+-------------------------------------+
| Address                        |                                     |
+--------------------------------+-------------------------------------+
| Authorized COST RECORD         | ##                                  |
|                                |                                     |
|                                | ## RECORD OF PAYMENT APPLICATIONS   |
+--------------------------------+-------------------------------------+
| Original Authorization         | Cost to Date Including Fee          |
| \$\_\_\_\_\_\_\_               | \$\_\_\_\_\_\_\_\_\_\_\_\_\_\*      |
+--------------------------------+-------------------------------------+
|                                | Previous Net Billing                |
|                                | \$\_\_\_\_\_\_\_\_\_\_\_            |
|                                |                                     |
|                                | Previous Retention                  |
|                                | \$\_\_\_\_\_\_\_\_\_\_\_            |
+--------------------------------+-------------------------------------+
| Amendment Authorized           | Previous Gross Billing              |
| \$\_\_\_\_\_\_\_\_             | (\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_)    |
+--------------------------------+-------------------------------------+
| Through Amendment              | Gross Billing this Application      |
| No.\_\_\_\_\_\_                | \$\_\_\_\_\_\_\_\_\_                |
+--------------------------------+-------------------------------------+
| Authorization to Date          | Less: Retention this Application    |
| \$\_\_\_\_\_\_\_\_             | (\$\_\_\_\_\_\_\_\_\_)              |
+--------------------------------+-------------------------------------+
|                                | Net Billing this Application        |
|                                | \$\_\_\_\_\_\_\_\_\_\_              |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
| Signature                      | Name (Print or Type)                |
+--------------------------------+-------------------------------------+

\*This amount should equal the total cost and fee invoiced.

Form 18303

Page 2 of 3

First Attachment to Application for Payment

##  Contract No.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##  Month\_\_\_\_\_\_\_\_\_\_\_\_ 19\_\_\_\_

[This Month]{.underline} [Total to Date]{.underline}

1\. DIRECT MATERIALS

A. Purchased Parts (if applicable)

1\. Expendable (itemize on Form BC-1006-075)

2\. Nonexpendable (itemize on Form BC-1006-076)

Subtotal \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

B. Subcontracted items (itemize on attachment)

C. Other

Subtotal \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Total Direct Materials \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

2\. Material Overhead \_\_\_\_% of Line No. \_\_\_\_

3\. Direct Labor (specify individual and/or CURRENT MONTH

categories - itemize premium) (hours)

Subtotal \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

4\. Labor Overhead (specify Cost Center) CURRENT MONTH

(%)

Subtotal \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

5\. Special Testing

6\. Special Equipment (itemize on Form BC-1006-76)

7\. Travel (itemize on attachment)

8\. Consultants (itemize)

9\. Other Direct Cost (itemize on Attachment) \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_

10\. Total Direct Cost and Overhead

11\. General and Administrative \_\_% of Line Nos. \_\_

12\. Total Cost

13\. Fee \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

14\. Total Cost and Fee \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Form 18303

Page 3 of 3

Second Attachment to Application for Payment

Contract No.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Month\_\_\_\_\_\_\_\_\_\_\_\_ 19\_\_\_\_

[SUPPORTING DOCUMENTATION]{.underline}

[Subcontract]{.underline}

[Name]{.underline} [Description of Services]{.underline} [This
Month]{.underline} [Total to Date]{.underline}

\$ \$

[TRAVEL BREAKDOWN]{.underline}

Billed

[Date(s)]{.underline} [Destination]{.underline} [Mode of
Travel]{.underline} [Individual(s)]{.underline} [Purpose
Cost]{.underline}

[OVERTIME BREAKDOWN]{.underline}

[Date]{.underline} [Individuals]{.underline} [Hours]{.underline}
[Purpose]{.underline} [Premium Cost]{.underline}

[OTHER DIRECT COST]{.underline}

[Item]{.underline} [Rate]{.underline} [Billed Cost]{.underline}