CONTRACT NO. This is the number assigned by the City of Tampa for the bid or proposal. • W.O.# If the report covers a work order number (W.O.#) for the contract, please indicate it in that space. • Contract Name. This is the name of the contract assigned by the City of Tampa for the bid or proposal. • Contractor Name. The name of your business. • Address. The physical address of your business. • Federal ID. A number assigned to a business for tax reporting purposes. • Phone. Telephone number to contact business. • Fax. Fax number for business. • Email. Provide email address for electronic correspondence. • Pay Period. Provide start and finish dates for pay period. (e.g. 05/01/13 – 05/31/13) • Payment Request/Invoice Number. Provide sequence number for payment requests. (ex. Payment one, write 1 in space, payment three, write 3 in space provided.) • City Department. The City of Tampa department to which the contract pertains. • Total Amount Requested for pay period. Provide all dollars you are expecting to receive for the pay period. • Total Contract Amount (including change orders). Provide expected total contract amount. This includes any change orders that may increase or decrease the original contract amount. • Signed/Name/Title/Date. This is your certification that the information provided on the form is accurate. • See attached documents. Check if you have provided any additional documentation relating to the payment data. Located at the bottom middle of the form. • Partial Payment. Check if the payment period is a partial payment, not a final payment. Located at the top right of the form. • Final Payment. Check of this period is the final payment period. Located at the top right of the form. The following instructions are for information of any and all subcontractors used for the pay period.
Appears in 4 contracts
Samples: Agreement for Consultant Services, Agreement for Construction Management Services, Agreement for Consultant Services
