REQUEST FOR PAYMENT OF MATERIAL ON HAND

Primary Information

Application Information

Material On Hand

Item and

Description

Number

(0000-0000)

Material

Description

and Location

Unit

of

Meas

Received

This

Period

Previous

Quantity

On

Hand

Used This

Period

Balance

On

Hand

Unit

Price

$

Total

Installed

to Date

Plan

Qty

Total Value

          $

Grand Total

Affirmation

“By submitting a request for Material on Hand (MOH) payment, the Contractor expressly authorizes the Texas Department of Transportation (Department) to audit MOH records, and to perform process reviews of the record-keeping system. If the Department determines noncompliance with any of the requirements of the contract, the Department may exclude payment for any or all MOH for the duration of the Contract”: