Annex 40

Republic of the Philippines

PLGU LOGO
PHILIPPINE RURAL DEVELOPMENT PROJECT
Province of___, Region___.

CERTIFICATE OF PAYMENT
Sub-project : C.O.P. No.
Municipality : Period Ending:
Province : Remarks:
Contractor :
1 I certify that this certificate is correct, and that no payment for the same has been received.
Certified by:

Contractor's Representative

2 Iwork,
certify that I have checked the amount covered in this certificate ; that the work was actually accomplished and performed; that the
quantities and amounts are wholly consistent with the requirements of all Contract Documents.
Certified by:

PPMIU Engineer Date

3 Certificate Recommended for Payment by:

PPMIU Head Date

4 Certificate Approved for Payment by:

Local Chief Executive Date

5 VALUE OF ACCOMPLISHMENT
5.1 TOTAL ADVANCE PAYMENT : P
a.) Previous Recoupment : P
b.) Balance on Advance Payment : P
5.2 ORIGINAL CONTRACT AMOUNT P
Add/Less: Approved Change Order (Additive/Deductive)
a.) C.O. Nos. ___ to ____ : P
b.) Liquidated Damages : P
5.3 TOTAL CONTRACT AMOUNT P
5.4 PERCENTAGE OF ACCOMPLISHMENT TO DATE : %
5.5 TOTAL AMOUNT OF ACCOMPLISHMENT TO DATE : P
5.6 LESS PREVIOUS PAYMENTS:
a.) Recoupment of Downpayment : P
b.) Previous Payments : C.O.P. Nos.____ to ___ : P
c.) 10% Retention P
d.) Expanded Witholding Tax P
e.) Revised Value Added Tax P P

5.7 VALUE OF ACCOMPLISHMENT P

Less:
a.) Recoupment of Downpayment : P
b.) 10% Retention P
c.) ExpandedWitholding Tax (Gross Billing/1.12 x 2%) P
d.) Revised Value Added Tax (Gross Billing/1.12 x 5%) P P

5.8 AMOUNT DUE THIS CERTIFICATE : P

Add: Unpaid Previous Certificate
C.O.P. Nos ___ to ___ P
5.9 NET AMOUNT DUE AND PAYABLE : P
5.10 CONTRACT BALANCE AFTER THIS CERTIFICATE : P
5.11 CONTRACT BALANCE BEFORE THIS CERTIFICATE : P

6 ATTACHMENTS:
- Statement of Work accomplished (SWA) - Change order/variation order (if any)
with validation by Joint Inspection Team - Progress geotag photographs

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