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( Project (Payee Signature (original signature only no stamps)TitleDate Submitted( Payee Identification Number NJCFS DOC# - FOR STATE OF NEW JERSEY USE ONLY  *Payee - See Instructions On Reverse Side *( Attachment Checklist: FORMCHECKBOX A.DPMC-11-2, Monthly Estimate For Partial Payment FORMCHECKBOX K.DPMC-607, A/E Documentation Form FORMCHECKBOX B.DPMC-11-2a, Certification Of Prime Contractor FORMCHECKBOX L.Project Progress Schedule FORMCHECKBOX C.DPMC-11-2b, Certification of Subcontractor FORMCHECKBOX M.Other: FORMCHECKBOX D.Copy of Subcontractor Contract(s) (Attached or On File) FORMCHECKBOX E.Copy of Subcontractor Invoice(s) FORMCHECKBOX F.DPMC-11-3, Prime Contractors Summary Of Stored Material FORMCHECKBOX G.DPMC-11-3a, Agreement And Bill Of Sale Certification For Stored Material FORMCHECKBOX H.Consent Of Surety FORMCHECKBOX I.Certified Payroll Records (Attached Or On File) FORMCHECKBOX J.AA-202, Monthly Project Workforce Report( Payment Requested Adjusted Contract Amount ($ Total Value Of Work In Place/Complete ($Retainage _ __ %$Net Total Previously Billed+$ Total Deductions (-$Net Payment Due This Period ( $FOR STATE OF NEW JERSEY USE ONLYDATE RECEIVED FOR REVIEW:Certification By Contract Management I certify that this invoice complies with the contract, and that the required documentation is attached.Certification By Fiscal Officer I certify that this invoice is correct. Payment is authorized.(Invoice must be signed or rejected within 20 calendar days of this date)SignatureSignatureAuthorized SignatureTitleDateTitleDateTitleDate PAYEE INSTRUCTIONS Items ( Through (Are To Be Completed By Payee ( DPMC Project/Contract Number Enter Project/Contract Number in this format: A####-##-AA## ( Payee Invoice Number Payee invoice, billing number or any other identification for reference purposes. This information is recorded on the check stub and aids the payee in identifying the invoices that have been paid. Do not use more than 31 characters. ( Invoice Period Timeframe during which services were rendered for this billing. Do not include timeframes for services already billed. ( Vendor Name & Address The Name of the Individual or Company that appears on the DPMC contract. ( Project The Project Name and Location where services were furnished. ( Payee Identification Number Federal identification number that you submitted on your W9 form to the Office of Management and Budget. ( Payee Declaration Payee must read and sign this declaration. Original signatures only no stamps. ( Attachments Checklist Mark the items on the list that correspond to the attachments included with this invoice. ( Payment Requested Adjusted Contract Amount: add approved contract modifications to the original contract amount. Total Value of Work-In-Place/Complete: value of work completed to date. Retainage: enter the percentage for retainage to be withheld as stipulated in your contract (or as modified in writing from the Director); multiply the percentage times the total value of work in place/complete. Net Total Previously Billed: enter the total amount of payments you have requested to date (whether or not received) minus any adjustments made to them by the State in the past. 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