Appendix C Form 1FSa – CONSULTANT’S APPLICATION FOR PAYMENT (Full Service Agreements) Submit application in duplicate to SUCF Controller together with required paid-up bills and schedules. On this page, complete parts 1-6. to the Fund’s on Payment of Consultant Fees” for detailed instructions. “Bulletin 1 2 PAY TO: (Name and Address) PAYEE REFERENCE NUMBERS a. Contract Number D- b. SUCF Project Number c. Consultant’s Project Number d. Payee Identification Number 3 I hereby make application for payment upon my contract with the University Construction Fund for: at 4 5 SUMMARY OF PAYMENT REQUEST CONSULTANT’S CERTIFICATION Fill in applicable lines only. I hereby certify that I am the person in name the foregoing Include details and computations on pages 2 and 3. account is rendered; that the services and property charged have been performed or delivered; that the sums charged are Program Verification Payment $ reasonable and just; that all requirements of said contract have been complied with; and, that no part of the foregoing account has been previously paid. Concept Phase Payment $ Schematic Payment $ Design Manual Payment $ Construction Documents Payment $ Signature Date Additional forms required. Construction Phase Payment $
Appendix C – Form 1FSa CONSULTANT’S APPLICATION FOR PAYMENT (Full Service Agreements) Submit application in duplicate to SUCF Controller together with required paid-up bills and schedules. On this page, complete parts 1-6. to the Fund’s “Bulletin on Payment of Consultant Fees” for detailed instructions. 1 PAY TO: (Name and Address) 2 PAYEE REFERENCE NUMBERS a. Contract Number D- b. SUCF Project Number c. Consultant’s Project Number d. Payee Identification Number 3 I hereby make application for payment upon my contract with the University Construction Fund for: at 4 SUMMARY OF PAYMENT REQUEST Fill in applicable lines only. Include details and computations on pages 2 and 3. 5 CONSULTANT’S CERTIFICATION I hereby certify that I am the person in name the foregoing account is rendered; that the services and property charged have been performed or delivered; that the sums charged are reasonable and just; that all requirements of said contract have been complied with; and, that no part of the foregoing account has been previously paid. Program Verification Payment $ Concept Phase Payment $ Schematic Payment $ Design Manual Payment $ Construction Documents Payment $ Signature Date Construction Phase Payment $ Additional forms required.
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