Schedule G
Revision date 7/2007
PROGRESS PAYMENT FORM FOR PRIME CONTRACTORS/CONSULTANTS
For use by all city agencies and departments for construction and professional services contracts.
To be completed by the prime contractor/consultant and be submitted each time a payment is requested.
Project Name Name of Prime Contractor/Consultant
Project Number Address
Phone
Subcontractors/Sub-consultants &
Suppliers/Services
Original
Contract
Amount
Change
Order $
Amounts
Total
Contract
Amount
Total
Payment to
date
Payment for
this period
Balance
Remaining
in Project
Under penalty of perjury the undersigned agrees that the forgoing information is true and correct.
Name and Title ________________________________________________________________________ Date ____________________
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