CONTRACTOR’S CLAIMS Republic of the Philippines

Department of Public Works and Highways

DAVAO CITY II DISTRICT ENGINEERING OFFICE
Tugbok Proper, Davao City
For the period: __________________________________________

PROJECT ID : 17LH0171
NAME OF PROJECT : Construction of Standrad 2 Storey 6 Classrooms Building at Payment Certification No.: _4
Sheet No:
Tibuloy Elementary School, Toril District, davao City Date:

NAME OF CONTRACTOR: FIVE MASSIVE INFRA AND SUPPLY CORP., 9. I hereby certify that the attached Statement of Work is correct and just and does not
ORIGINAL CONTRACT AMOUNT : P 11,751,991.10 include items and/or portions, thereof for which payment has already been received. In
REVISED CONTRACT AMOUNT : N/A regard to Item covering advance payment for MATERIALS, THE SAID MATERIALS
are on site and are properly protected.
1. TOTAL VALUE OF WORK TO DATE P 11,751,991.10
2. TOTAL VALUE OF WORK PREVIOUSLY P 10,546,831.02
3. TOTAL VALUE OF WORK THIS BILLING P 1,175,160.08
4. DEDUCTION SABINO O. BONADOR
A) 10% RETENTION P_____ - __ Contractor’s Representative
Recoupment from Advance P -
Sub-total P -
B) 2% WITHHOLDING TAX P 20,985.00 10. I hereby certify that the materials incorporated in this monthly certificate for payment
5% VAT P 52,462.50 have been verified and tested in accordance with Specifications.
Others (Specify) P - I hereby certify that the quantity of work approved for payment in the attached statement
Sub-total P 73,447.50 have been accomplished that the quantities including materials brought to site but not
TOTAL DEDUCTIONS P 73,447.50 incorporated in the work are correct and consistent with all previous recommendation for
5. AMOUNT APPROVED FOR PAYMENT P 1,101,712.58 payment and the work quantities and accounts are consistent with the requirements of the
6. ADD: REQUEST NO.____ for materials currently on hand P contract.
7. ADD: REQUEST NO.____ for previous payment materials on hand P
8. NET AMOUNT DUE CONTRACTOR P 1,101,712.58 ALFREDO G. MASADO
Project Engineer (DPWH)
SCHEDULED PHYSICAL PROGRESS: 100.00 % Checked and Reviewed by:
ACTUAL PHYSICAL PROGRESS: 100.00 % APPROVED FOR PAYMENT:
SLIPPAGE (-) OR (+) (+) %
CONTRACT EXPIRY DATE: July 30, 2018 GENE P. LOZANO
REYNALDO A. AMORES
Chief, Const. Section District Engineer