Spreadsheet: 461d18f2-c493-434a-9490-da594a002e11
Sheet: Progress Invoice Request

 | Proc Form |  | PROGRESS INVOICE REQUEST |  |  |  |  |  |  |  |  |  |  |  | Progress Invoice No.:
 | PROC-2123 |  | FOR CONSTRUCTION SUBCONTRACTS |  |  |  |  |  |  |  |  |  |  |  | Subcontractor Invoice No.:
 | (rev. 07-11) |  | PROJECT TITLE: |  |  |  |  |  |  |  |  |  |  |  | Invoice(s) Attached:
 | Subcontractor: |  |  |  |  |  |  |  |  |  | Contract No.: |  |  |  | Original Contract Amount:
 | Address: |  |  |  |  |  |  |  |  |  | Subcontract Start Date: |  |  |  | Subcontract Completion Date:
 | Request for Payment |  |  |  |  |  |  |  |  |  |  | Amendment(s) Summary
 | 1- | ORIGINAL CONTRACT AMOUNT |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Additions |  |  | Deductions
 | 2- | Net Approved Amendment(s) |  |  |  |  |  |  |  |  |  | Total changes approved in previous months by BEA via Amendment(s)
 | 3- | CONTRACT SUM TO DATE
 | 4- | TOTAL COMPLETED & STORED TO DATE
 | 5- | RETAINAGE: |  |  |  |  |  |  |  |  |  | Total changes approved by BEA via Amendment(s) this month
 |  | a.  % of Completed Work
 |  | (Column D + E on Progress Invoice Estimate)
 |  | [NAME] of Stored Material |  |  |  |  |  |  |  |  |  | Total approved schedule impacts |  |  |  |  |  |  |  | Days
 |  | (Column F on Progress Invoice Estimate)
 |  | Total in Column J on Progress Invoice Estimate |  |  |  |  |  |  |  |  |  | NET CHANGES by Amendment(s)
 | 6- | TOTAL EARNED LESS RETAINAGE
 | 7- | LESS PREVIOUS PAYMENT REQUEST(S)
 | 8- | CURRENT PAYMENT REQUEST |  |  |  |  |  |  |  |  |  | RELEASE OF CLAIMS
 | 9- | BALANCE TO FINISH, INCLUDING RETAINAGE |  |  |  |  |  |  |  |  |  | As consideration for the issuance of this progress payment, the Subcontractor for itself, its predecessors, successors, and assigns, hereby releases and forever discharges BEA, the U.S. Government and their respective officers, agents, employees, successors, and assigns, jointly and severally, from any and all liabilities, claims, demands, losses, costs, expenses, actions or causes of action of whatever kind or character arising under or in connection with this Contract on or before the date of preparation as noted on this progress invoice. Any pending claims shall be listed in the area below, for future resolution between the parties. Any future discussions pertaining to claims already released, shall be considered as settlement discussions and not as reopening of a claim issue.
 | CERTIFICATE OF THE SUBCONTRACTOR
 | I hereby certify that the work performed and the materials supplied to date, as shown on the above represent the actual value of accomplishment under the terms of the Contract (and all authorized changes thereto) between the undersigned and Battelle Energy Alliance, LLC (BEA), and their respective officers, agents, employees, successors relating to the above referenced contract.  I also certify that all laborers, materialmen, suppliers, contractors, and subcontractors used on or in connection with the performance of this contract have been paid in full, except as noted.  I further certify that I have complied with all Federal, State, and Local tax laws, including Social Security laws and Unemployment Compensation laws and Workmen's Compensation laws insofar as applicable to the performance of this Contract.  I further certify I have complied with all provisions relating to labor laws and regulations (including current Certified Payrolls) applicable to the work under this Subcontract.
 |  |  |  |  |  |  |  |  |  |  |  | NOTED CLAIM(S)
 |  |  |  |  |  |  | Subcontractor Signature |  |  |  |  |  | Date
 | BEA Approvals
 |  | CERTIFICATION BY CFR:
 |  | Scheduled % Complete |  |  |  | Actual % Completed
 |  |  |  |  |  |  |  |  |  |  |  | Total Request |  |  | (Retainage) |  |  | Authorized Amount to be Paid
 |  | Vendor Data Current/Accepted |  |  | Yes |  | No
 |  |  |  |  |  |  |  |  |  |  |  | Pay Authorization No. |  |  | Please Pay Subcontractor by |  |  | Final Payment
 | Construction Field Representative Approval Signature |  |  |  |  |  |  | Date
 | Project Manager Approval Signature |  |  |  |  |  |  | Date |  |  |  | Subcontract Administrator Approval Signature |  |  |  |  |  |  | Date