Form 39-1 "Contractor's Payment Summary - Contract Work Only" - New York City

What Is Form 39-1?

This is a legal form that was released by the New York City Department of Parks and Recreation - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2015;
  • The latest edition provided by the New York City Department of Parks and Recreation;
  • 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 printable version of Form 39-1 by clicking the link below or browse more documents and templates provided by the New York City Department of Parks and Recreation.

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Download Form 39-1 "Contractor's Payment Summary - Contract Work Only" - New York City

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Contractor’s Payment Summary – Contract Work Only
Form 39-1
PAYMENT NO: ________________
a. Cost of Contract Work to Date
$
(a)
b. Amount Due for Stored Material
$
(b)
c. Total Amount to Date (a + b)
$
(c)
d. Retained Percentage* for Contract Work Only
$
(d)
e. Total Contract Work Previously Certified
$
(e)
f. Liquidated Damages
$
(f)
g. Net Amount due this estimate (c-d-e-f)
$
(g)
h. Less Amount Withheld, Reason: _______________________
$
(h)
i. Payment Due this Estimate
$
(g–h)
*Partial = 5%, Substantial completion = 1% + 2 x P.L., Final = 1%. Final = 0%, if guarantee release accompanies payment.
CONTRACTOR'S CERTIFICATE
I (we) certify that all items, units, quantities and prices of work and material shown on this estimate are correct; that all
work has been performed and material supplied in full accordance with the terms and conditions of the contract between
Department of Parks and Recreation of the City of New York and ______________(Contractor) dated __________ and all
authorized change thereto; that all contract provisions relating to prevailing wages have been complied with; that all
outstanding claims for labor, materials and equipment for the performance of said contract except the outstanding claims
listed in the attached sheet, "Certificate of Contractor to the Comptroller" and as listed below; that the above is true and
correct statement of the contract account up to and including the last day of the period covered by this estimate and that
no part of the "payment due this estimate" has been received. The following is a true and correct list of all subcontractors
who have employed laborers and/or used material and/or supplies for work performed under said contract. Furthermore in
compliance with Article 35, Section 6 of the Agreement, I (we) certify that I (we) have complied with Section 6-108 of the
New York City Administrative Code relating to non-discrimination, with the non-discrimination provisions of Section 220e of
the New York State Labor Law and with Section 6-108 of the New York City Administrative Code and subsequently
enacted rules and regulations or amendments thereto relating to minimum wage.
SUBCONTRACTOR'S NAME
TRADE
VALUE PREVIOUSLY PAID
VALUE THIS REQUEST
REFER TO ATTACHED FORM 44 – SUBCONTRACTOR COMPLIANCE REPORT
__________________________
Contractor's Signature
Date
Agency Contract No.
________________________________________________
Title
Contractor Company Name
RESIDENT ENGINEER'S CERTIFICATE
I certify that I have verified this estimate and that to the best of my knowledge and belief it is a true and correct statement of
the work performed and materials supplied by the contractor, and that all work and material included in this estimate have
been inspected by me or my duly authorized assistants and have found to comply with the terms and conditions of the
corresponding construction contract documents and authorized changes thereto. I further certify that I have verified that
certificates of non-discrimination have been obtained from the contractor and all subcontractors who performed any work
covered by this payment.
Contract Time
CC Days
Percent of Work Completed ______________ %
Total Time Consumed to Date ____________ Days
Percent of Time Elapsed _________________%
Resident Engineer Signature: ___________________________
Date: _________________________________
Resident Engineer Printed Name: __________________________
R.E. Phone Number: ______________________
Submit Form To: Borough Director, Resident Engineer, Data Systems
Revised GB: 7/15
Contractor’s Payment Summary – Contract Work Only
Form 39-1
PAYMENT NO: ________________
a. Cost of Contract Work to Date
$
(a)
b. Amount Due for Stored Material
$
(b)
c. Total Amount to Date (a + b)
$
(c)
d. Retained Percentage* for Contract Work Only
$
(d)
e. Total Contract Work Previously Certified
$
(e)
f. Liquidated Damages
$
(f)
g. Net Amount due this estimate (c-d-e-f)
$
(g)
h. Less Amount Withheld, Reason: _______________________
$
(h)
i. Payment Due this Estimate
$
(g–h)
*Partial = 5%, Substantial completion = 1% + 2 x P.L., Final = 1%. Final = 0%, if guarantee release accompanies payment.
CONTRACTOR'S CERTIFICATE
I (we) certify that all items, units, quantities and prices of work and material shown on this estimate are correct; that all
work has been performed and material supplied in full accordance with the terms and conditions of the contract between
Department of Parks and Recreation of the City of New York and ______________(Contractor) dated __________ and all
authorized change thereto; that all contract provisions relating to prevailing wages have been complied with; that all
outstanding claims for labor, materials and equipment for the performance of said contract except the outstanding claims
listed in the attached sheet, "Certificate of Contractor to the Comptroller" and as listed below; that the above is true and
correct statement of the contract account up to and including the last day of the period covered by this estimate and that
no part of the "payment due this estimate" has been received. The following is a true and correct list of all subcontractors
who have employed laborers and/or used material and/or supplies for work performed under said contract. Furthermore in
compliance with Article 35, Section 6 of the Agreement, I (we) certify that I (we) have complied with Section 6-108 of the
New York City Administrative Code relating to non-discrimination, with the non-discrimination provisions of Section 220e of
the New York State Labor Law and with Section 6-108 of the New York City Administrative Code and subsequently
enacted rules and regulations or amendments thereto relating to minimum wage.
SUBCONTRACTOR'S NAME
TRADE
VALUE PREVIOUSLY PAID
VALUE THIS REQUEST
REFER TO ATTACHED FORM 44 – SUBCONTRACTOR COMPLIANCE REPORT
__________________________
Contractor's Signature
Date
Agency Contract No.
________________________________________________
Title
Contractor Company Name
RESIDENT ENGINEER'S CERTIFICATE
I certify that I have verified this estimate and that to the best of my knowledge and belief it is a true and correct statement of
the work performed and materials supplied by the contractor, and that all work and material included in this estimate have
been inspected by me or my duly authorized assistants and have found to comply with the terms and conditions of the
corresponding construction contract documents and authorized changes thereto. I further certify that I have verified that
certificates of non-discrimination have been obtained from the contractor and all subcontractors who performed any work
covered by this payment.
Contract Time
CC Days
Percent of Work Completed ______________ %
Total Time Consumed to Date ____________ Days
Percent of Time Elapsed _________________%
Resident Engineer Signature: ___________________________
Date: _________________________________
Resident Engineer Printed Name: __________________________
R.E. Phone Number: ______________________
Submit Form To: Borough Director, Resident Engineer, Data Systems
Revised GB: 7/15