Payment Certificate for Construction Example [Edit & Download]

Project Information:

• Project Name: City Center Revitalization Project
• Location: 488 Revival Blvd, Midtown, Urban City
• Contract Number: CC-2026-156

Contractor Information:

• Contractor Name: Apex Building Innovations
• Address: 3245 Builder’s Square, Urban City, UC 67890
• Contact Details: Linda Hart, Site Manager, (333) 444-5566

Certificate Number:

• PC-2026-315

Period Covered:

• From: May 1, 2025
• To: May 31, 2025

Description of Work Performed:

• Foundation Work: Completed the excavation and pouring of concrete foundations for the north and south zones of the project.
• Structural Framing: Assembled and erected steel frames for sections A and B of the commercial district within the project scope.
• Electrical Installation: Initiated and completed the rough wiring of the residential units in the east wing.
• Plumbing and HVAC: Installed main plumbing lines and HVAC ductwork for the central facilities area.

Certified Progress:

• Scheduled Progress: 60% completion as per project timeline.
• Actual Progress: 58% achieved; 2% behind schedule due to supply chain delays.

Value of Work Completed:

• This Period’s Claimed Value: $750,000
• Total Claimed to Date: $3,750,000

Amount Certified:

• Total Certified to Date: $3,500,000
• Less Previous Certificates: $2,750,000
• Amount Due This Certificate: $750,000
• Retention (5%): $37,500
• Net Amount Due: $712,500

Certifier Details:

• Certifier: Jameson Clarke, Chief Engineer
• Signature: [Signature Jameson Clarke]

Date of Issue:

• Issued on: June 10, 2025

Additional Notes:
The work has been verified against project specifications and all regulatory compliance issues have been addressed. The minor delay due to supply chain issues is recognized, and measures are being taken to mitigate further delays. Payment is recommended to maintain project momentum and to ensure timely procurement of materials for subsequent phases.