Payment Certificate for Contractor Example [Edit & Download]

Project Information:

• Project Name: Gateway Plaza Redevelopment
• Location: 77 Revival Rd., Uptown, New State
• Contract Number: GP-2025-311

Contractor Information:

• Contractor Name: Vertex Builders LLC
• Address: 908 Industrial Parkway, Suite 500, New State, NS 50123
• Contact Details: Richard Nolan, Project Director, (777) 890-5566

Certificate Number:

• PC-2025-033

Period of Work:

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

Description of Work Performed:

• Task 1: Installation of underground utilities and sewer lines across the north section of the site.
• Task 2: Construction of the main lobby and parking structure up to the third level.
• Task 3: Implementation of eco-friendly roofing systems on building A.

Certified Progress:

• Work Certified This Period: 95% completion of scheduled tasks.
• Cumulative Work Certified: 45% of total project work.

Amount Due:

• Total Contract Value: $3,500,000
• Work Done This Period Value: $400,000
• Previous Certificates Total: $1,350,000
• Current Certificate Amount: $400,000
• Retention (5%): $20,000
• Net Amount Due This Period: $380,000
• Notes: Amount reflects adjustments for material cost increases and penalties for one-week delay due to unforeseen weather conditions.

Certifier Details:

• Certifier: Sarah Kim, Lead Contract Administrator
• Signature: [Signature Sarah Kim]

Date of Issue:

• Issued on: April 5, 2025

Additional Information:

• Remarks: The contractor has adhered to all safety and environmental regulations. The delay caused by weather has been noted and accepted as a non-penalizable delay. All work inspected complies with the architectural plans and specifications laid out in the contract.