Prompt Payment Certification

2177.pdf

In accordance with the requirements of Article 9.9, submit this certification to the Engineer prior to the end of the month as follows

each month payment received (example: Work performed in January. Contractor paid in February. Contractor must submit certification no later than the end of March) and

the month following the month when final acceptance occurred (example: Final acceptance occurs in January. Contractor must submit the final certification no later than the end of February).

Note that the Contractor may make final submission prior to acceptance, if all subcontractor work is complete and all supplier materials have been furnished for the project, and the subcontractors' and suppliers' final payments have been made in full.

Failure to submit this form or provide prompt payment in accordance with the contract may result in the Engineer withholding payment or suspending the work. This certification is applicable to materials the Contractor purchases to remain as part of the final project, to first-tier subcontractors on the project and associated project specific locations (subcontractors and suppliers are to comply with the prompt payment requirements).

Certification

"I certify that to the best of my knowledge and with the exception of those subcontractors or suppliers listed below, all subcontractors and suppliers have been paid in accordance with the contract (10 days after receiving payment for the work performed by the subcontractor) and that any retainage held on a subcontractor or supplier's work has been released within 10 days after satisfactory completion of all of the subcontractors' or suppliers' work."

Project Number

CCSJ

Estimate Period

Final Subcontractor and Supplier Payment Date

Signature

Title

Date

Printed Name

The following firms have not been paid for reasons listed:

Firm	* Reason for Non-Payment

*Only reasons based on dispute of subcontractor or supplier noncompliance may be accepted.

This is a government document certifying satisfactory completion of the requirements of Article 9.9 of the contract regarding the payment of subcontractors. A Contractor may be sanctioned under department rules for filing a false certification.