Form 39-2 "Contractor's Payment Summary for Change Order Work" - New York City

What Is Form 39-2?

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 39-2 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 39-2 "Contractor's Payment Summary for Change Order Work" - New York City

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Contractor’s Payment Summary
Form 39-2
Change Order Work Only
PAYMENT NO. _______________________
a. Total Cost of Change Order Work to Date
$________________(a)
b. Retained Percentage* for Change Order Work
$________________(b)
c. Total Change Order Work Previously Certified
$________________(c)
d. Net Amount due this estimate (a-b-c)
$________________(d)
e. Less Amount withheld, Reason_________________________
$________________(e)
f.
Payment
$________________(d&e)
*Partial = 5%, Substantial Completion and 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 the Department of Parks and Recreation of the City of New York,
I (we)__________________ (Contractor) and all authorized change(s) 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.
Furthermore, in compliance with Article 35 Section 6 and Article 36 of the Agreement, I (we) certify that
I (we) have complied with Section 6-108 of the New York City Administrative Code relating 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.
Contractor’s Signature______________________________________ Date_______________________
Title________________________
Contractor’s 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 sub-contractors who performed any work covered by this payment.
Resident Engineer______________________________
Date______________________________
Submit Form To: Borough Director, Resident Engineer
Revised: 7/15
Contractor’s Payment Summary
Form 39-2
Change Order Work Only
PAYMENT NO. _______________________
a. Total Cost of Change Order Work to Date
$________________(a)
b. Retained Percentage* for Change Order Work
$________________(b)
c. Total Change Order Work Previously Certified
$________________(c)
d. Net Amount due this estimate (a-b-c)
$________________(d)
e. Less Amount withheld, Reason_________________________
$________________(e)
f.
Payment
$________________(d&e)
*Partial = 5%, Substantial Completion and 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 the Department of Parks and Recreation of the City of New York,
I (we)__________________ (Contractor) and all authorized change(s) 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.
Furthermore, in compliance with Article 35 Section 6 and Article 36 of the Agreement, I (we) certify that
I (we) have complied with Section 6-108 of the New York City Administrative Code relating 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.
Contractor’s Signature______________________________________ Date_______________________
Title________________________
Contractor’s 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 sub-contractors who performed any work covered by this payment.
Resident Engineer______________________________
Date______________________________
Submit Form To: Borough Director, Resident Engineer
Revised: 7/15