FORM APPROVED
OMB NO. 0575-0042
CONTRACT NO.
Form RD 1924-18
(Rev. 6-97)
UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT
FARM SERVICE AGENCY
PARTIAL PAYMENT ESTIMATE NO.
PARTIAL PAYMENT ESTIMATE
PAGE
OWNER: CONTRACTOR: PERIOD OF ESTIMATE
FROM TO
CONTRACT CHANGE ORDER SUMMARY ESTIMATE
AmountAgency Approval
1. Original Contract
No.
Date Additions Deductions
2. Change Orders
3. Revised Contract (1 + 2)
4. Work Completed*
5. Stored Materials*
6. Subtotal (4 + 5)
7. Retainage*
8. Previous Payments
9. Amount Due (6-7-8)
TOTALS
* Detailed breakdown attached
NET CHANGE
CONTRACT TIME
Original (days)
Revised On Schedule Yes Starting Date
NoRemaining Projected Completion
ARCHITECT OR ENGINEER'S CERTIFICATION:
CONTRACTOR'S CERTIFICATION:
The undersigned certifies that the work has been carefully
inspected and to the best of their knowledge and belief, the
quantities shown in this estimate are correct and the work has
been performed in accordance with the contract documents.
The undersigned Contractor certifies that to the best of their
knowledge, information and belief the work covered by this
payment estimate has been completed in accordance with
the contract documents, that all amounts have been paid by
the contractor for work for which previous payment estimates
was issued and payments received from the owner, and that
current payment shown herein is now due.
Architect or Engineer
Contractor
By
By
Date
Date
ACCEPTED BY AGENCY:
The review and acceptance of this estimate does not attest to
the correctness of the quantities shown or that the work has
been performed in accordance with the contract documents.
APPROVED BY OWNER:
Owner
By
By
Title
Date
Date
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0575-0042. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information.
RD 1924-18 (Rev. 6-97)
$0.00
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$0.00
TYPICAL UNIT PRICE BREAKDOWN *
CONTRACT (revised)
TOTAL TO DATE
THIS PERIOD
%
COM-
UNIT
PRICE
DESCRIPTION
ITEM
AMOUNT
QUANTITY
AMOUNTQUANTITYAMOUNT
QUANTITY
PLETE
TOTALS
TYPICAL STORED MATERIALS
AND RETAINAGE BREAKDOWN *
TYPICAL LUMP SUM PRICE BREAKDOWN *
MATERIALS STORED AT END OF THIS PAYMENT PERIOD
WORK COMPLETED
%
COM-
SCHEDULED
VALUE
UNIT
VALUE
DESCRIPTION
ITEM
AMOUNTTO DATETHIS PERIOD
QUANTITY
DESCRIPTION
PLETE
RETAINAGE
RETAINED
PERCENT
THIS ESTIMATE
%
WORK COMPLETED:
STORED MATERIALS:
OTHER (explain)
TOTALS
TOTAL
* As a minimum, detailed breakdowns should contain this information.
RD 1924-18
REVERSE
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