OMB Approval No. 2900-0208
Estimated burden 12 minutes
REPORT FOR PERIOD ENDING
CONTRACT PROGRESS REPORT
Centra Texas Health Care System (CTVHCS)
LOCATION OF PROJECT
1901 Memorial Drive
TO
Temple, TX 76504
5. DATE CONST. STARTED
1. PROJECT NO.
2. CONTRACT NO.
3. DATE CONTRACT AWARD
4. DATE NOTICE TO PROCEED RECEIVED
6. NAME AND ADDRESS OF CONTRACTOR
7. DESCRIPTION OF CONTRACT
8. ORIGINAL CONTRACT AMOUNT
12. EXTENDED CONTRACT COMPLETION DATE
9. SCHEDULED PERCENT COMPLETION
13. ESTIMATED COMPLETION DATE
10. ACTUAL PERCENT COMPLETION
14. DATE COMPLETED
11. ORIGINAL CONTRACT COMPLETION DATE
VALUE OF WORK IN
VALUE OF WORK INSTALLED
ITEM
BRANCH OF WORK
TOTAL VALUE
PLACE-END LAST PERIOD
IN CURRENT PERIOD
NO.
(A)
(B)
(C)
(D)
15.
16.
17.
18.
19.
20.
21.
22.
23.
VA FORM
10-6001a
JUN 2012
OMB Approval No. 2900-0208
Estimated burden 12 minutes
REPORT FOR PERIOD ENDING
CONTRACT PROGRESS REPORT
Centra Texas Health Care System (CTVHCS)
LOCATION OF PROJECT
1901 Memorial Drive
TO
Temple, TX 76504
5. DATE CONST. STARTED
1. PROJECT NO.
2. CONTRACT NO.
3. DATE CONTRACT AWARD
4. DATE NOTICE TO PROCEED RECEIVED
6. NAME AND ADDRESS OF CONTRACTOR
7. DESCRIPTION OF CONTRACT
8. ORIGINAL CONTRACT AMOUNT
12. EXTENDED CONTRACT COMPLETION DATE
9. SCHEDULED PERCENT COMPLETION
13. ESTIMATED COMPLETION DATE
10. ACTUAL PERCENT COMPLETION
14. DATE COMPLETED
11. ORIGINAL CONTRACT COMPLETION DATE
VALUE OF WORK IN
VALUE OF WORK INSTALLED
ITEM
BRANCH OF WORK
TOTAL VALUE
PLACE-END LAST PERIOD
IN CURRENT PERIOD
NO.
(A)
(B)
(C)
(D)
15.
16.
17.
18.
19.
20.
21.
22.
23.
VA FORM
10-6001a
JUN 2012
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
SUPPLEMENTAL AGREEMENT - ADD
38.
SUPPLEMENTAL AGREEMENT - DEDUCT
39.
TOTAL
$$$
40.
VA FORM
10-6001a
JUN 2012
CONTRACT FISCAL DATA
41.
CURRENT CONTRACT AMOUNT (From Item 40, Col. B)
$
VALUE - WORK IN PLACE TO DATE (Item 40, Cols. C plus D)
42.
$
43.
VALUE - UNUSED MATERIALS PREVIOUSLY PAID FOR
$
44.
VALUE - UNUSED MATERIALS PAID FOR THIS PERIOD
$
EARNED TO DATE (Items 42 plus 43 plus 44)
45.
$
46.
RETAINAGE (Based on Item 45 less cost of bond premiums)
$
47.
$
TOTAL PREVIOUS PAYMENTS
48.
$
PAYMENT THIS PERIOD
49.
$
TOTAL PAYMENT TO DATE (Item 47 plus 48)
50.
VALUE - CONTRACT NOT EARNED (Item 41 minus 45)
$
51. EQUIPMENT STATUS
52. MATERIALS STATUS
53A. WORK PROGRESS
53B. PROGRESS FACTOR
54. SUBMISSIONS OVERDUE
CHANGE ORDERS, SUPPLEMENTAL AGREEMENTS, AND TIME EXTENSIONS
DATE
DAYS
APPROVED
EXTENSION
ITEM
SYMBOLS
ADDITIONS
DEDUCTIONS
NO.
(A)
(B)
(C)
(D)
(E)
55A.
CO SUPPL. AGREE. PREV. REPORTED, SYM
TO
INCL.
55B.
CO CHANGE ORD., PREV. REPORTED, NO.
INCL.
TO
55C.
FIELD SUPPL. AGREE. PREV. REPORTED, NO.
TO
INCL.
55D.
FIELD CHANGE ORD. PREV. REPORTED, SYM.
INCL.
TO
56.
TIME EXTENS. PREV. REPORTED, NO.
TO
INCL.
57.
ISSUED THIS PERIOD
58.
ISSUED THIS PERIOD
59.
ISSUED THIS PERIOD
60.
ISSUED THIS PERIOD
61. REMARKS
62. SIGNATURE OF RESIDENT ENGINEER
63. DATE
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in
accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may
not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a
valid OMB number. We anticipate that the time expended by all individuals who must complete this form will
average 12 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill
out the form. If your firm does not already have a similar form, this is used to record the data necessary to
assure the contractor provides sufficient labor and materials to accomplish the contract work. This form or a
similar document is required to guarantee the performance of the work necessary to complete the project.
VA FORM
10-6001a
JUN 2012
ADVERTISEMENT