Navfac 7300 30 Form – Fill Out and Use This PDF

NAVFAC 7300/30		NAVAL FACILITIES ENGINEERING COMMAND
(Rev 2/01)
					DUNS NO:	________________
1. CONTRACTOR'S INVOICE					CAGE CODE NO:	________________
From:					Invoice Date
					Invoice Number
POC/Telephone/email for this invoice:
To:	Contract Specialist:
Below is a Statement of Performance under Contract N40085-						Task Order:
for			at

The enclosure provides breakdown of this statement of performance.

A.Total value of contract/task order through change

B.Percentage of performance complete

C.Value of completed performance

D.Less total of prior payments

E.Amount of this invoice

Signature and Title:

Date:

2. FIRST ENDORSEMENT

Receipt and Acceptance Certification

From:

To:

1.Payment is recommended as follows:

A.Amount of work completed to (date)

B.Less: Retention Other Deductions:

C.Subtotal

D.Less previous payments

E. Certified amount for payment #

F.Elapsed contract time (if applicable)

G.Responsible Certifying UIC

H.Invoice Receipt Date

I.Material/Services Receipt Date

J.Material/Services Acceptance Date

K.Date forwarded to paying office

L.I certify this amount is correct and payment is recommended.

Signature:Date:

Signature of Authorized Representative

Name and Title (typed):

Phone and address:

3. PROMPT PAYMENT CERTIFICATION

I certify that the accounting data provided is accurate, funds have been obligated in appropriate accouting system and changes have been applied to the apprpriate accounting classification reference number (ACRN), available funds have been decremented for the amount approved for disbursement and will not be de-obligated and the aboave invoice is correct and proper for payment.

Signature:Date:

Signature of Authorized Representative

Name and Title (typed):

Phone and address:

Line(s) of accounting to be used for this invoice (include appropriate Line Item # (CLIN, SLIN, or ACRN, etc)

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