DOCUMENT

02c1 - 537-19-124 SOW Att - Contract Progress Report.pdf

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Original Source
Contract Opportunity
Date Originally Posted
Jan. 19, 2022, 9:40 a.m.
Type
.pdf
Size
0.53MB
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None

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EXTRACTED TEXT

OMB Approval No. 2900-0208
Estimated burden 12 minutes

REPORT FOR PERIOD ENDING

CONTRACT PROGRESS REPORT

LOCATION OF PROJECT

Centra Texas Health Care System (CTVHCS)
1901 Memorial Drive
Temple, TX 76504

1. PROJECT NO.

2. CONTRACT NO.

3. DATE CONTRACT AWARD

4. DATE NOTICE TO PROCEED RECEIVED

5. DATE CONST. STARTED

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

BRANCH OF WORK

TOTAL VALUE

VALUE OF WORK IN
PLACE-END LAST PERIOD
VALUE OF WORK INSTALLED
IN CURRENT PERIOD
VA FORM
JUN 2012 10-6001a

SUPPLEMENTAL AGREEMENT - ADD

SUPPLEMENTAL AGREEMENT - DEDUCT

TOTAL

VA FORM

JUN 2012 10-6001a

CONTRACT FISCAL DATA

CURRENT CONTRACT AMOUNT (From Item 40, Col. B)

VALUE - WORK IN PLACE TO DATE (Item 40, Cols. C plus D)

VALUE - UNUSED MATERIALS PREVIOUSLY PAID FOR

VALUE - UNUSED MATERIALS PAID FOR THIS PERIOD

EARNED TO DATE (Items 42 plus 43 plus 44)

RETAINAGE (Based on Item 45 less cost of bond premiums)

TOTAL PREVIOUS PAYMENTS

PAYMENT THIS PERIOD

TOTAL PAYMENT TO DATE (Item 47 plus 48)

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

SYMBOLS

DATE
APPROVED

DAYS
EXTENSION

ADDITIONS

DEDUCTIONS

CO SUPPL. AGREE. PREV. REPORTED, SYM

CO CHANGE ORD., PREV. REPORTED, NO.

FIELD SUPPL. AGREE. PREV. REPORTED, NO.

FIELD CHANGE ORD. PREV. REPORTED, SYM.

TIME EXTENS. PREV. REPORTED, NO.

INCL.

INCL.

INCL.

INCL.

INCL.

ISSUED THIS PERIOD

ISSUED THIS PERIOD

ISSUED THIS PERIOD

ISSUED THIS PERIOD

61. REMARKS
NO.

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

JUN 2012 10-6001a