NYC 9/11 Public Portal Document
DEPARTMENT OF CITYWIDE ADMINISTRATIVE SERVICES
Payment Routing/Certification Records
Part I: P^ment Data
[ ] FMC [ v?DRES [ ]OEC
I. Contract CP # Capisid # PkJ 13
2. Project Name/Descrmtion
3. RE/PM Name Tele^one#
4. Contractor/ConsultantVendor" ______________ __________
5. Contract Type ( Check all that apply) [Capital [ ] Expense [ ] Construction [ ] Lump Sum
[ ] Unit Price [ ] Requirements [ ] CM Build/Design Build [ ] Open Market Order
[ ] Consultant [ ] Other (please state)__________________________________________
6. Payment .# *7 Amount Due $5^^/ 3 _____ Pay Per._______ To_______
7. Payment Type (Check all that apply) [] Partial [*^hange Order [] TaskWork Order
[ ] Substantial [QTinal [ ] Retainage [ ] Bond Substance [ ] Article 17
[ ] Other (please state)_______________________________________________________
Part II: Processing Dates
I. In From Contractor 0/ RE/PM In RE/PM Sign. Off
2, Budget In Date Budget Out Date Budget Rejection Date
3. Reason for Budget Rejection
4. FMC/DRES/OEC Out Date FMC/DRES/OEC Rejection Date
5. Reason for FMC/DRES/OEC Rejection
6. EAO In Date EAO Out Date EAO Rejection Date
7. EAO’s Reason for Rejection^
8. Audit In Date Audit Out Date Audit’s Rejection Date
9. Audit’s Reason for Rejection
Part III: Required SignaturesA provals
1. RE/PM Signoff
(DCAS Employees Only) Print Name
i)_ y lature ' Date
2. Budget Reviewer
Print Name Signature Date
3. EAO Auditor
Print Name Signature Date
4. Audit’s Auditor
Print Name Signature Date
NYC-WTC_000171432
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