CITY OF NEW YORK
DEPARTMENT OF DESIGN AND CONSTRUCTION
DIVISION OF INFRASTRUCTURE
CONTRACTOR’S DOCUMENT CHECKLIST: PAYMENTS
Contractor’s Name ___________________________________________ Contract Registration # _____________________
RE’s Managing Borough: [ ] BX [ ] BK [ ] M [ ] Q [ ] SI Requirements Contract? [ ] Yes [ ] No
Payment # ______________ Task Order # __________________ Pay Period: From _____________ to ____________
Payment Type: [ ] Partial [ ] Change Order [ ] Article 16 [ ] Substantial [ ] Final
Contractor to check off [/] all documentation submitted:
ORIGINALS COPIES
DOCUMENT
1
2
Contractor’s Document Checklist (this form)
[ ]
1
2
Contractor Non-Discrimination Certificate
[ ]
1
2
Contractor Comptroller’s Certificate (Notarized)
[ ]
1
1
Contractor’s Payroll Report (Certified) ***
[ ]
1
0
Material Test Certifications***
[ ]
1
0
Progress Photos ***
[ ]
IF CONTRACTOR HAS SUBCONTRACTORS:
1
2
Subcontractor Payment Form (Notarized)
[ ]
1
2
Subcontractor Comptroller’s Certificate (Notarized)
[ ]
1
2
Subcontractor’s Non-Discrimination Certificate
[ ]
1
1
Subcontractor Payroll Report (Certified)***
[ ]
IF CONTRACTOR HAS REQUESTED PAYMENT FOR STORED MATERIAL:*
1
2
Permission to Store Material
[ ]
1
2
Stored Material Summary Form
[ ]
0
3
Stored Material Invoices
[ ]
1
2
Affidavit: Vendor to Contractor (Notarized)
[ ]
1
2
Bill of Sale from Contractor to the City
[ ]
(Notarized Blumberg Form A100)
IF PAYMENT HAS ASBESTOS WORK:*
1
2
Waste Manifest Dump Ticket
[ ]
______________________________________________________________________________________________
* Insurance covering all stored material and asbestos work is required. For off-site storage, a Lease Agreement must be submitted and re