DCM Form C-10 "Application and Certificate for Payment - Psca" - Alabama

What Is DCM Form C-10?

This is a legal form that was released by the Alabama Department of Finance, Real Property Management - Division of Construction Management - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2021;
  • The latest edition provided by the Alabama Department of Finance, Real Property Management - Division of Construction Management;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DCM Form C-10 by clicking the link below or browse more documents and templates provided by the Alabama Department of Finance, Real Property Management - Division of Construction Management.

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Download DCM Form C-10 "Application and Certificate for Payment - Psca" - Alabama

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DCM Form C-10
Revised October 2021
DCM (BC) No. _____________________
PSCA Projects: PSCA No. _____________
APPLICATION and
Application No. ____________________
CERTIFICATE for PAYMENT
Date: _____________________________
Attach DCM Form C-10SOV: Schedule of Values
TO OWNER:
PROJECT:
Entity Name:
Address:
FROM CONTRACTOR: Company Name & Address,
which must exactly match
ARCHITECT / ENGINEER:
co. name & payment
Firm Name:
address spelling as
registered in State
Address:
of AL Accounting
& Resource System
(STAARS) to avoid
STAARS rejection:
STAARS Vendor #:
A. Total Original Contract
$
B. Fully Executed
Change Order(s) Numbers __ through __
+ __________________
(signed by all parties)
$
C. Total Contract To Date
$
(Form C-10SOV's
1. Work Completed to Date per attached Schedule of Values
$
Column F Total)
2. Materials
Presently
Stored
(When this amount is greater than $0.00, attach Form
+
__________________
$
C-10SM: Inventory of Stored Materials, or similar list)
3. Total Work Completed to Date & Materials
Presently
Stored
( ______% of Contract To Date)
$
(If Total Work Completed to Date & Materials Presently Stored (#3) is less than
_
Final pay app?
4. Less Retainage
or equal to 50% of Total Contract to Date (C), Retainage = #3 x 0.05.
__________________
$
Yes.
Once #3 exceeds 50% of C and up until project is complete, Retainage = C x 0.025.
$0 is retained on final payment application, see 9th bullet point below for requirements.)
5. Total Due
$
_
(Must exactly match #5 Total Due from previous
6. Less Total Previous Payments
Billed
__________________
payment application. # 6 is $0.00 if there is no
$
previous payment application)
7. Balance Due This Estimate
$
ARCHITECT'S / ENGINEER'S CERTIFICATION
CONTRACTOR'S CERTIFICATION
The undersigned Contractor certifies that to the best of his knowledge, information, and
In accordance with the Contract Documents, the Architect/
Engineer certifies to the Owner that, to the best of the Architect’s/
belief the Work covered by this Application for Payment has been completed in
Engineer's knowledge and belief, the Work has progressed to the
accordance with the Contract Documents, that all amounts have been paid by him for
Work for which previous Certificates for Payments were issued and payments received
point indicated herein, the quality of the Work is in accordance with
the Contract Documents, and the Contractor is entitled to payment of
from the Owner and that current payment shown herein has not yet been received.
the amount approved.
By: ________________________________________ Date: _________________
Contractor's Signature
By ____________________________________________________
Name & Title _________________________________________________________
Architect's / Engineer's Signature
Sworn and subscribed before me this ________ day of __________________________
Day
Month, Year
Name & Title __________________________________________
Seal:
Date _________________________________________________
___________________________________
Notary Public's Signature
APPROVAL
INSTRUCTIONS
Four copies of pay. app., each with original signatures and all attachments required.
Date of first payment application cannot precede the Notice to Proceed's Begin Date.
Pay. app. must exactly match an attached DCM Form C-10SOV: Schedule of Values.
_____________________________________________________
• A change order must be fully executed before inclusion on a payment application.
Owner Entity
• Contractor’s signature date cannot precede the payment application date.
Contractor and Notary signee dates must match.
By __________________________________________________
• Progress schedules must be included with non-final payment applications.
• One payment application per month may be submitted.
Signature
On a final payment application, the following is required for release of retainage: all
change orders must be fully executed (signed by all parties) and included, the
Name & Title ________________________________________
Certificate of Substantial Completion for entire work is fully executed, and all other
close-out requirements per General Conditions Article 34 are completed.
Date _______________________________________________
DCM Form C-10
Revised October 2021
DCM (BC) No. _____________________
PSCA Projects: PSCA No. _____________
APPLICATION and
Application No. ____________________
CERTIFICATE for PAYMENT
Date: _____________________________
Attach DCM Form C-10SOV: Schedule of Values
TO OWNER:
PROJECT:
Entity Name:
Address:
FROM CONTRACTOR: Company Name & Address,
which must exactly match
ARCHITECT / ENGINEER:
co. name & payment
Firm Name:
address spelling as
registered in State
Address:
of AL Accounting
& Resource System
(STAARS) to avoid
STAARS rejection:
STAARS Vendor #:
A. Total Original Contract
$
B. Fully Executed
Change Order(s) Numbers __ through __
+ __________________
(signed by all parties)
$
C. Total Contract To Date
$
(Form C-10SOV's
1. Work Completed to Date per attached Schedule of Values
$
Column F Total)
2. Materials
Presently
Stored
(When this amount is greater than $0.00, attach Form
+
__________________
$
C-10SM: Inventory of Stored Materials, or similar list)
3. Total Work Completed to Date & Materials
Presently
Stored
( ______% of Contract To Date)
$
(If Total Work Completed to Date & Materials Presently Stored (#3) is less than
_
Final pay app?
4. Less Retainage
or equal to 50% of Total Contract to Date (C), Retainage = #3 x 0.05.
__________________
$
Yes.
Once #3 exceeds 50% of C and up until project is complete, Retainage = C x 0.025.
$0 is retained on final payment application, see 9th bullet point below for requirements.)
5. Total Due
$
_
(Must exactly match #5 Total Due from previous
6. Less Total Previous Payments
Billed
__________________
payment application. # 6 is $0.00 if there is no
$
previous payment application)
7. Balance Due This Estimate
$
ARCHITECT'S / ENGINEER'S CERTIFICATION
CONTRACTOR'S CERTIFICATION
The undersigned Contractor certifies that to the best of his knowledge, information, and
In accordance with the Contract Documents, the Architect/
Engineer certifies to the Owner that, to the best of the Architect’s/
belief the Work covered by this Application for Payment has been completed in
Engineer's knowledge and belief, the Work has progressed to the
accordance with the Contract Documents, that all amounts have been paid by him for
Work for which previous Certificates for Payments were issued and payments received
point indicated herein, the quality of the Work is in accordance with
the Contract Documents, and the Contractor is entitled to payment of
from the Owner and that current payment shown herein has not yet been received.
the amount approved.
By: ________________________________________ Date: _________________
Contractor's Signature
By ____________________________________________________
Name & Title _________________________________________________________
Architect's / Engineer's Signature
Sworn and subscribed before me this ________ day of __________________________
Day
Month, Year
Name & Title __________________________________________
Seal:
Date _________________________________________________
___________________________________
Notary Public's Signature
APPROVAL
INSTRUCTIONS
Four copies of pay. app., each with original signatures and all attachments required.
Date of first payment application cannot precede the Notice to Proceed's Begin Date.
Pay. app. must exactly match an attached DCM Form C-10SOV: Schedule of Values.
_____________________________________________________
• A change order must be fully executed before inclusion on a payment application.
Owner Entity
• Contractor’s signature date cannot precede the payment application date.
Contractor and Notary signee dates must match.
By __________________________________________________
• Progress schedules must be included with non-final payment applications.
• One payment application per month may be submitted.
Signature
On a final payment application, the following is required for release of retainage: all
change orders must be fully executed (signed by all parties) and included, the
Name & Title ________________________________________
Certificate of Substantial Completion for entire work is fully executed, and all other
close-out requirements per General Conditions Article 34 are completed.
Date _______________________________________________