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 NAVAL FACILITIES ENGINEERING COMMAND
A - E CONTRACTOR'S INVOICE
CONTRACT SPECIALIST:_____________________________
INVOICE DATE:__________________
PROJECT NO. D. O. #______________________________
INVOICE NUMBER:_______________
PROJECT TITLE:______________________________________________________________________________
FROM:
TO: COMMAND, CODE 0211
1. Below is a Statement of Performance under Contract N68711________________________________________
at (Station)___________________________________________________________________________________
The enclosure provides breakdown of this statement of performance.
A. Total value of contract through change ________________
$______________________
B. Percentage of performance complete
______________________%
C. Value of completed performance
$______________________
D. Less: Total of prior invoice
$______________________
E. Amount of this invoice
$
Signature and Title:_____________________________________________
From:
Date:____________________
To:
1. Payment is recommended as follows:
A. Amount of work completed to _______________
$_______________________
B. Less:
Retention: $______________________
Other Deductions: $_______________
C. Subtotal:
$________________
D. Less Previous payments
$________________
E. Recommended amount for _________________payment
$_________________
RESPONSIBLE CERTIFYING ACTIVITY UIC
________________________________________________
INVOICE RECEIPT DATE
_______________________________________________
MATERIAL/SERVICES RECEIPT DATE
_________________________________________________
MATERIAL/SERVICES ACCEPTANCE DATE
_________________________________________________
DATE FORWARDED TO PAYING ACTIVITY
________________________________________________
I CERTIFY THIS AMOUNT IS CORRECT AND PAYMENT IS RECOMMENDED:
_______________________________________________
__________________________
SIGNATURE/TITLE
DATE
ACRN
APPN/SUBHEAD OC
BCN
SA
AAA
TT
PAA
COST CODE
AMOUNT
Exhibit 10-B
198
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