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 NAVFAC 7300/41 (7/85)
NAVAL FACILITIES ENGINEERING COMMAND
CONTRACTOR'S INVOICE
(1)
INVOICE DATE
(2)
INVOICE NUMBER
(3)
FROM:
TO:
Officer in Charge of Construction
VIA:
Resident Officer in Charge of Construction
1. Below is a Statement of Performance under Contract
(4)
(5)
at (Station)
The enclosure provides breakdown of this statement of performance
A. Total value of contract through change
(6)
(7)
$
B. Percentage of performance complete
(8)
%
C. Value of completed performance
(9)
$
D. Less: Total of prior invoices
(10)
$
E. Amount of this invoice
(11)
$
(12)
Signature and Title
Date
FIRST ENDORSEMENT
FROM: ROICC
TO:
1. Payment is recommended as follows:
A. Amount of work completed to
$
B. Less: Total of prior invoices
$
C. Amount of this invoice
$
D. Less: Retention this invoice
(0 to 10% of Item C)
$
Total retention prior invoices
$
Other deductions
$
$
E. Sub-total
$
F Less previous payments
$
G. Recommended amount for
payment
$
2. Elapsed contract time
%
3.
Signature and Title
1
ROICC
Pursuant to authority vested in me. I certify that this invoice is correct and proper for payment.
Signature and Title
DATE
1
Authorized Certifying Officer
OC
BCN
SA
ACRN APPN/SUBHEAD
PAA
AAA
TT
COST CODE
AMOUNT
1
If the ability to certify and authority to recommend are combined in one person, one signature only is necessary; otherwise the ROICC will sign in
the space provided.
*
U.S.
Government
Printing
Office:
1988-505-007/90632
2.1
S/N
0105-LF-003-0205
1-13
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