NJSDA Form 813
Rev. 04/03/12
ADDED THIS
REPORTING PERIOD
CONTRACTOR'S SUMMARY OF STORED MATERIALS
(OFF-SITE STORED MATERIALS/EQUIPMENT LIST)
NJSDA Form 813
Page of
Contract No.:
Contractor Name:
Invoice No.:
Contractor Address:
Invoice Date:
Project Description:
Quantity Amount
STORED PREVIOUS
REPORTING PERIOD
Item No.
Description of Item
(include Model, Serial No., etc.)
USED DURING THIS
REPORTING PERIOD
AmountQuantity
BALANCE END OF THIS
REPORTING PERIOD
AmountQuantity
AmountQuantity
TOTALS
Submitted By:
Contractor:
Signature Printed Name
Date
Recommended By:
PMF/CM:
Signature
Project Manager (Printed Name)
Date
Approved Not ApprovedRecommended Not Recommended
Approved By:
SDA:
Date
Program Officer (Printed Name)
Signature
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