Billing Format In Excel Free Download 30786

Partial file snippet.
Sheet 1: Cost Plus Form

	
	
	
	
	
	
	
	
	
	
	
	
	
	
		Company Letterhead/Logo (Optional)
		

		

		

		

		

		

		Date Received
		

		Date Stamp Optional
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		Rec by (Init)
		

		

		

		

		

		

		

	
	
		North Carolina Department of Transportation
		

		

		

		

		

		

		

	
	
		Cost Plus Cover Sheet
		

		

		

		

		

		

		

	
	
		                                                          Consultant Professional Services Contracts           
		

		P.O. Payment Sequence No.
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		NCDOT LSC No.
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		NCDOT Purchase Order/Task Order No.
		

		

		

		

		

		

		

	
	
		Contact Information:
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Firm Name
		

		

		NCDOT Client Name
		

		

		

		

		

		

		

		

	
	
		Firm Remittance Address
		

		

		NCDOT Client Address
		

		

		

		

		

		

		

		

	
	
		Firm Contact Information 
(Name, Email and Phone)
		

		NCDOT Client Contact Information
(Email and Phone)
		

		

		

		

		

		

		

	
	
		Firm Vendor No.
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Firm Tax ID No.
		

		

		Project Information (For Project Specific Assignments):
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		STIP Number
		

		

		

		

		

		

		

		

	
	
		Invoice Information:
		

		

		

		

		WBS Number
		

		

		

		

		

		

		

		

	
	
		Partial Billing    
		

		Final Billing       
		

		

		Federal Aid Number (if applicable)
		

		

		

		

		

		

		

		

	
	
		Firm's Internal Invoice No.
		

		

		County(ies)
		

		

		

		

		

		

		

		

	
	
		Date of Invoice
		

		

		Project Description
		

		

		

		

		

		

		

	
	
		Invoice Period Covered
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Applicable Rates:
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Home Office Overhead
		

		

		Home FCCM
		

		

		

		Operating Margin (Fee Amount)
		

		

		

		

		

		

		

		

	
	
		Field Office Overhead
		

		

		Field FCCM
		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Work Completed This Invoice: (Insert additional item numbers, as needed.)
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		P.O. Line Item/ Tracking No.
		Activity
		WBS # (If Multiple in PO)
		$ Line Item Total
		$ Fee Remaining
		$ Total Fee Billed to Date
		$ Total Fee Billed Last Invoice
		Subconsultant Name *
		$ Due Subconsultant This Invoice*
		$ Fee Billed This Invoice
		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		$0.00
		$0.00
		

		

		

		

		

		

		

		

		

		

	
	
		

		Totals:
		

		$0.00
		$0.00
		$0.00
		$0.00
		

		$0.00
		$0.00
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		Total Amount Due This Invoice:
		$0.00
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Purchase Order Tracking:
		

		

		Supplement Tracking (Complete if Supplements Received (insert additional rows, if needed)):
		

		NCDOT Review:
		

		

		

		

		

		

		

		

	
	
		Total PO Amount
		

		

		Original PO Amount
		

		

		NCDOT Review
		(If different from approver or as required)
		

		

		

		

		

		

	
	
		Amount Previously Billed
		

		

		List Total Supplement 1
		

		

		Reviewed By
		

		

		

		

		

		

		

	
	
		Amount Billed to Date
		$0.00
		

		List Total Supplement 2
		

		

		

		

		

		

		

		

	
	
		% Billed to Date
		#DIV/0!
		

		Total PO Amount
		$0.00
		

		Printed Name
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		Date
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		FIRM:
		

		

		

		NCDOT Approval: Percent Complete Approved
		

		

		

		

		

		

		

		

		

		

		

	
	
		I hereby certify that the amount billed is true and correct to the best of my knowledge and that payment has not been received.
		Invoice Document No. (SAP)
		

		

		

		

		

		

		

		

		

	
	
		Signature:
		

		

		Approved By**:
		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

	
	
		Printed Name:
		

		

		Printed Name:
		

		

		

		

		

		

		

		

		

		

	
	
		Date:
		

		

		Date:
		

		

		

		

		

		

		

		

		

		

	
	
		PEF Maintains a FAR compliant accounting system
		

		

		**Invoice must be approved by NCDOT.
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Submit:  Cover Sheet, Prime (Firm) and Subconsultant (if applicable) Internal Invoices, signed timesheets with backup including rates, Subconsultant Pay Form (if applicable), Timesheet Summary (use provided template or equivalent accounting output), and Progress Report.
		

		

		

		

		

		

		

	
	
		Note:  Invoices are scanned into the NCDOT Fiscal Accounting System.  Please do not highlight or shade any figures.
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Invoice Breakdown
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		P.O. Line Item/ Tracking No.
		WBS No.
		$ Direct Labor
		$ Overhead Amount
		$ Operating Margin 
		$ Cost of Capital
		$ Total Premium Labor
		$ Direct Costs
		$ Total by WBS
		

		

		

		

		

		

		

	
	
		
		Ken Gilland:
Enter the PO Line Item Number on the Purchase Order associated with the work performed under each WBS number
		

		
		Ken Gilland:
Enter the WBS Element number associated with the project for which work was performed
		

		
		Ken Gilland:
Enter the total direct labor charges for the project WBS element
		

		
		Ken Gilland:
Enter the total overhead charges (Home or Field Office) for the project WBS element
		

		
		Ken Gilland:
)  Enter the Operating Margin (Fee Amount) associated with the direct labor and overhead charges for the project WBS element
		

		
		Ken Gilland:
Enter the cost of capital charges (Home or Field) for the project WBS element
		

		
		Ken Gilland:
Enter the total amount of premium labor charges for overtime labor costs and shift premium labor costs for the project WBS element
		

		
		Ken Gilland:
Enter the total direct costs for the project WBS element.  Examples include trucks, mileage, equipment costs, etc
		

		
		Ken Gilland:
Enter the sum total of items 29 through 34 for each project WBS element
		$0.00
		

		

		

		

		

		

		

	
	
		

		
		Ken Gilland:
Note:  If there are multiple WBS numbers for a PO, they should be listed separately
		

		

		

		

		

		

		

		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		$0.00
		

		

		

		

		

		

		

	
	
		

		Grand Totals:
		$0.00
		$0.00
		$0.00
		$0.00
		$0.00
		$0.00
		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		Revision Date: 5/11/2022
		

		

		

		

		

		

	



Sheet 2: Example_Cost Plus

	
	
	
	
	
	
	
	
	
	
	
	
	
	
		Company Letterhead/Logo (Optional)
		

		

		

		

		

		

		Date Received
		
		Ken Gilland:
The date received if filled in by the NCDOT person who receives the invoice
		8/5/2021
		Date Stamp Optional
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		Rec by (Init)
		
		Ken Gilland:
The NCDOT Person who received the invoice should place their initials here
		KJ
		

		

		

		

		

		

	
	
		North Carolina Department of Transportation
		

		

		

		

		

		

		

	
	
		Cost Plus Cover Sheet
		

		

		

		

		

		

		

	
	
		                                             Consultant Professional Services Contracts   
		

		

		P.O. Payment Sequence No.
		
		Ken Gilland:
Enter the NCDOT Invoice Number. The number should be generated by the PEF. This is the number that goes in SAP
		0028
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		NCDOT LSC No.
		
		Ken Gilland:
Enter the NCDOT Limited Service Contract Number
		7000056844
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		NCDOT Purchase Order/Task Order No.
		
		Ken Gilland:
Enter the NCDOT Purchase Order/Task Order Number
		6300091423
		

		

		

		

		

		

	
	
		Contact Information:
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Firm Name
		

		
		Ken Gilland:
Enter the firm name that is listed on the firms internal invoice under remit payment to.
		ACME, INC
		NCDOT Client Name
		

		
		Ken Gilland:
Enter the NCDOT Project Manager's name and Unit.
		 R. Runner, NCDOT Division 15
		

		

		

		

		

		

	
	
		Firm Remittance Address
		

		
		Ken Gilland:
Enter the firm remittance address that is listed on the firms internal invoice under remit payment to.
		6000 Universal Blvd, Orlando, FL 32819
		NCDOT Client Address
		

		
		Ken Gilland:
Enter the NCDOT Unit Mailing Address
		125 Speedway Drive, Birdseye, NC 29845
		

		

		

		

		

		

	
	
		Firm Contact Information 
(Name, Email and Phone)
		
		Ken Gilland:
Enter the firm contact information, including the point of contact for billing questions and/or the Project Manager.
		Wile E Coyote, Wcoyote@Warner.com, (407) 224-4233
		NCDOT Client Contact Information
(Email and Phone)
		
		Ken Gilland:
Enter the NCDOT Project Manager/Contract Administrator's contact information, including their email address and phone number
		rrunner@ncdot.gov 252-693-5555
		

		

		

		

		

		

	
	
		Firm Vendor No.
		

		
		Ken Gilland:
Enter the Firm's NCDOT Vendor Number issued by the NCDOT Professional Services Management Unit.
		88888
		

		

		

		

		

		

		

		

		

		

		

	
	
		Firm Tax ID No.
		

		
		Ken Gilland:
Enter the Firm's Tax ID information
		123-475-8960
		Project Information (For Project Specific Assignments):
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		STIP Number
		

		
		Ken Gilland:
Enter the NCDOT STIP Number(s), if available
		U-9999
		

		

		

		

		

		

	
	
		Invoice Information:
		

		

		

		

		WBS Number
		

		
		Ken Gilland:
Enter the WBS Number.
		88575.1.FS2
		

		

		

		

		

		

	
	
		Partial Billing    
		
		Ken Gilland:
Use Pull-downs to indicate if the invoice is a partial or final billing for the services provided.
		Yes
		Final Billing   
		

		Federal Aid Number (if applicable)
		

		
		Ken Gilland:
Enter the Federal Aid Project Number(s), if available.
		BR549-0049(55)
		

		

		

		

		

		

	
	
		Firm's Internal Invoice No.
		

		
		Ken Gilland:
Enter the PEF's software generated invoice number.
		12345
		County(ies)
		

		
		Ken Gilland:
Enter the County(ies) where the project is located.
		Spotsylvania
		

		

		

		

		

		

	
	
		Date of Invoice
		

		
		Ken Gilland:
Enter the date the invoice was approved to send to NCDOT
		8/2/2021
		Project Description
		
		Ken Gilland:
Provide a brief project description
		Widen SR 9945B5 to 27 lanes
		

		

		

		

		

		

	
	
		Invoice Period Covered
		

		
		Ken Gilland:
Enter the Dates of the Invoice Period
		7/1/2021 - 7/31/2021
		

		

		

		

		

		

	
	
		
		Ken Gilland:
Any additional information the PEF wishes to include in the form can be included here, just insert lines
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Applicable Rates:
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Home Office Overhead
		
		Ken Gilland:
Enter the Firm's Home Office Overhead, as approved by the NCDOT's Office of Inspector General's Consultant, Utility, Railroad and Turnpike Unit
		181%
		

		Home FCCM
		

		
		Ken Gilland:
Enter the Firm's Home FCCM rate, as approved by the NCDOT's Office of Inspector General's Consultant, Utility, Railroad and Turnpike Unit (if applicable).
		1.23%
		

		Operating Margin (Fee Amount)
		

		
		Ken Gilland:
Enter the negotiated operating margin (fee) for the purchase order/task order
		9%
		

		

		

		

		

		

	
	
		Field Office Overhead
		
		Ken Gilland:
Enter the Firm's Field Office Overhead, as approved by the NCDOT's Office of Inspector General's Consultant, Utility, Railroad and Turnpike Unit (if applicable).
		153%
		

		Field FCCM
		

		
		Ken Gilland:
Enter the Firm's Field FCCM rate, as approved by the NCDOT's Office of Inspector General's Consultant, Utility, Railroad and Turnpike Unit (if applicable)
		1.15%
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Work Completed This Invoice: (Insert additional item numbers, as needed.)
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		P.O. Line Item/ Tracking No.
		Activity
		WBS # (If Multiple in PO)
		$ Line Item Total
		$ Fee Remaining
		$ Total Fee Billed to Date
		$ Total Fee Billed Last Invoice
		Subconsultant Name *
		$ Due Subconsultant This Invoice*
		$ Fee Billed This Invoice
		

		

		

		

		

		

	
	
		
		Ken Gilland:
Enter the PO Line Item Number on the Purchase Order associated with the work performed under each WBS number
		10
		
		Ken Gilland:
Insert the activity name as shown in the NTP
		PDEA Planning
		
		Ken Gilland:
Enter the WBS Element number associated with the project for which work was performed. STIP numbers can be used in this field, if necessary (such as if invoices include work on multiple STIP numbers statewide).
		48569.3.1
		
		Ken Gilland:
Enter the Line Item Total for the Listed Activity
		$20,000.00
		
		Ken Gilland:
Enter the amount in dollars of fee remaining in this task
		$14,394.86
		
		Ken Gilland:
Enter the total fee billed to date (including this invoice)
		$5,605.14
		
		Ken Gilland:
Enter the total fee previously billed (not including this invoice) for the Listed Activity
		$4,159.88
		
		Ken Gilland:
Enter the name of the subconsultant (only use if a subconsultant is included in that P.O. Line Item Number)
		

		
		Ken Gilland:
Enter the amount the subconsultant (if applicable) is billing for this invoice
		

		
		Ken Gilland:
List the total amount (PEF and subconsultants) for which the PEF is requesting payment for this invoice period for the listed task
		$1,445.26
		

		

		

		

		

		

	
	
		20
		PDEA Planning Roadway
		
		Ken Gilland:
Note:  If there are multiple WBS numbers for a PO, they should be listed separately
		48569.3.1
		$90,000.00
		$58,212.17
		$31,787.83
		$27,005.21
		Finley Engineering
		$4,782.62
		$4,782.62
		

		

		

		

		

		

	
	
		30
		PDEA Planning Con. Man.
		48569.3.1
		$40,000.00
		$1,450.20
		$38,549.80
		$30,517.11
		

		

		$8,032.69
		

		

		

		

		

		

	
	
		40
		PDEA Planning Hydraulics
		48569.3.1
		$80,000.00
		$80,000.00
		$0.00
		$0.00
		

		

		$0.00
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Totals:
		

		$230,000.00
		$154,057.23
		$75,942.77
		$61,682.20
		

		$4,782.62
		$14,260.57
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		Total Amount Due This Invoice:
		$14,260.57
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Purchase Order Tracking:
		

		

		Supplement Tracking (Complete if Supplements Received (insert additional rows, if needed)):
		

		NCDOT Review:
		

		

		

		

		

		

		

		

	
	
		Total PO Amount
		
		Ken Gilland:
Enter the Total Purchase Order Amount
		$230,000.00
		

		Original PO Amount
		
		Ken Gilland:
Enter the Total Purchase Order Amount for the Original Task Order
		$230,000.00
		

		NCDOT Review
		
		Ken Gilland:
Signature of NCDOT Reviewer (can be electronic)
		(If different from approver or as required)
		

		

		

		

		

		

	
	
		Amount Previously Billed
		
		Ken Gilland:
Enter Amount Previously Billed
		$61,682.20
		

		List Total Supplement 1
		
		Ken Gilland:
Enter the Total Amount of Supplement 1
		

		

		Reviewed By
		
		Ken Gilland:
Signature of NCDOT reviewer (can be electronic)
		

		

		

		

		

		

		

	
	
		Amount Billed to Date
		
		Ken Gilland:
Enter Total Amount Billed Including this Invoice
		$75,942.77
		

		List Total Supplement 2
		
		Ken Gilland:
Enter Total Amount of Supplement 2 (add more lines for additional supplements if necessary)
		

		

		

		

		

		

		

		

	
	
		% Billed to Date
		
		Ken Gilland:
Enter Percent Billed to Date (the amount billed to date divided by the total PO amount)
		33.02%
		

		Total PO Amount
		
		Ken Gilland:
Enter Total of Original Task order and All Supplements 
		$230,000.00
		

		Printed Name
		
		Ken Gilland:
Printed Name of NCDOT Reviewer
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		Date
		
		Ken Gilland:
Date of Review by NCDOT Reviewer
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Firm Certification:
		

		

		

		NCDOT Approval: Percent Complete Approved
		

		

		

		

		

		

		

		

		

		

		

	
	
		I hereby certify that the amount billed is true and correct to the best of my knowledge and that payment has not been received.
		Invoice Document No. (SAP)
		
		Ken Gilland:
The Invoice Document Number is generated by the Department in SAP
		

		

		

		

		

		

		

		

		

	
	
		Signature:
		
		Ken Gilland:
Include signature of PEF Project Manager (can be electronic)
		
 
		
		

		Approved By**:
		
		Ken Gilland:
Include signature of NCDOT approver (can be electronic)
		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

	
	
		Printed Name:
		

		Printed Name:
		

		
		Ken Gilland:
Printed name of person approving invoice for NCDOT
		

		

		

		

		

		

		

		

		

	
	
		Date:
		
		Ken Gilland:
Date of Certification by PEF Project Manager
		8/2/2021
		

		Date:
		

		
		Ken Gilland:
Date of Certification by NCDOT Approver 
		

		

		

		

		

		

		

		

		

	
	
		PEF Maintains a FAR compliant accounting system
		
		Ken Gilland:
Does the firm maintain a FAR timekeeping system that allows for electronic approval of timesheet?
		Yes
		

		**Invoice must be approved by NCDOT.
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Submit:  Cover Sheet, Prime (Firm) and Subconsultant (if applicable) Internal Invoices, signed timesheets with backup including rates, Subconsultant Pay Form, if applicable), Timesheet Summary (use provided template or equivalent accounting output), and Progress Report.
		

		

		

		

		

		

		

	
	
		Note:  Invoices are scanned into the NCDOT Fiscal Accounting System.  Please do not highlight or shade any figures.
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Invoice Breakdown
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		P.O. Line Item/ Tracking No.
		WBS No.
		$ Direct Labor
		$ Overhead Amount
		$ Operating Margin 
		$ Cost of Capital
		$ Total Premium Labor
		$ Direct Costs
		$ Total by WBS
		

		

		

		

		

		

		

	
	
		
		Ken Gilland:
Enter the PO Line Item Number on the Purchase Order associated with the work performed under each WBS number
		10
		
		Ken Gilland:
Enter the WBS Element number associated with the project for which work was performed. STIP numbers can be used in this field, if necessary (such as if invoices include work on multiple STIP numbers statewide).
		48569.3.1
		
		Ken Gilland:
Enter the total direct labor charges for the project WBS element
		$450.00
		
		Ken Gilland:
Enter the total overhead charges (Home or Field Office) for the project WBS element
		$814.50
		
		Ken Gilland:
)  Enter the Operating Margin (Fee Amount) associated with the direct labor and overhead charges for the project WBS element
		$113.81
		
		Ken Gilland:
Enter the cost of capital charges (Home or Field) for the project WBS element
		$16.95
		
		Ken Gilland:
Enter the total amount of premium labor charges for overtime labor costs and shift premium labor costs for the project WBS element
		$0.00
		
		Ken Gilland:
Enter the total direct costs for the project WBS element.  Examples include trucks, mileage, equipment costs, etc
		$50.00
		
		Ken Gilland:
Enter the sum total of items 29 through 34 for each project WBS element
		$1,445.26
		

		

		

		

		

		

		

	
	
		20
		
		Ken Gilland:
Note:  If there are multiple WBS numbers for a PO, they should be listed separately
		48569.3.1
		$1,246.40
		$2,142.44
		$305.00
		$38.79
		$0.00
		$1,050.00
		$4,782.62
		

		

		

		

		

		

		

	
	
		30
		48569.3.1
		$2,503.35
		$4,303.01
		$612.57
		$91.25
		$200.00
		$322.51
		$8,032.69
		

		

		

		

		

		

		

	
	
		40
		48569.3.1
		$0.00
		$0.00
		$0.00
		$0.00
		$0.00
		$0.00
		$0.00
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		Grand Totals:
		$4,199.75
		$7,259.95
		$1,031.37
		$146.99
		$200.00
		$1,422.51
		$14,260.57
		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		Revision Date: 5/12/2022
		

		

		

		

		

		

	



Sheet 3: Sub_Pay_Form

	
	
	
	
	
	
	
	
	
	
	
	
	
		Company Letterhead/Logo (Optional)
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Sub Pay Form
		

		P.O. Payment Sequence No.
		0
		

		

		

		

	
	
		

		

		

		

		

		

		

		NCDOT LSC No.
		0
		

		

		

		

	
	
		

		

		

		

		

		

		

		NCDOT Purchase Order/Task Order No.
		0
		

		

		

		

	
	
		Contact Information:
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Firm Name
		

		0
		NCDOT Client Name
		

		0
		

		

		

		

	
	
		Firm Remittance Address
		

		0
		NCDOT Client Address
		

		0
		

		

		

		

	
	
		Firm Contact Information 
(Name, Email and Phone)
		0
		NCDOT Client Contact Information
(Email and Phone)
		0
		

		

		

		

	
	
		Firm Vendor No.
		

		0
		

		

		

		

		

		

		

		

		

	
	
		Firm Tax ID No.
		

		0
		Project Information (For Project Specific Assignments):
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		STIP Number
		

		0
		

		

		

		

	
	
		Invoice Information:
		

		

		

		

		WBS Number
		

		0
		

		

		

		

	
	
		Partial Billing    
		

		Final Billing   
		

		Federal Aid Number (if applicable)
		

		0
		

		

		

		

	
	
		Firm's Internal Invoice No.
		

		12/30/1899
		County(ies)
		

		0
		

		

		

		

	
	
		Date of Invoice
		

		12/30/1899
		Project Description
		0
		

		

		

		

	
	
		Invoice Period Covered
		

		12/30/1899
		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Subconsultant Name
		

		

		

		

		

		

		

		

		

		

		

	
	
		P.O. Line Item/ Tracking No.
		Sub Invoice # to Prime1
		Sub Invoice Date1
		Sub Invoice Total1 $
		P.O. Payment Sequence No. to NCDOT w/sub2
		P.O. Payment Sequence Date2
		NCDOT Payment Date to Prime3
		Date Subconsultant Paid2
		Amount Subconsultant Paid2 $
		Days Column H Minus Column G
		

		

		

		

	
	
		Format
		number
		date
		number
		number
		date
		date
		date
		number
		Col H - Col G
		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		0 days
		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		0 days
		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		0 days
		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		0 days
		

		

		

		

	
	
		FIRM
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		I hereby certify that the amount billed is true and correct to the best of my knowledge.
		

		

		

		

		

		

		

	
	
		Signature:__________________________________________
		

		

		

		1Subconsultant Responsible for Invoicing Prime
		

		

		

		

		

	
	
		

		

		

		2Prime Consultant Responsible
		

		

		

		

		

	
	
		Printed Name/Title:_________________________________
		

		

		

		3NCDOT Responsible
		

		

		

		

		

	
	
		Date:______________________________________________
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		Revision Date: 5/11/2022
The words contained in this file might help you see if this file matches what you are looking for:

...Sheet cost plus form company letterheadlogo optional date received stamp rec by init north carolina department of transportation cover consultant professional services contracts po payment sequence no ncdot lsc purchase ordertask order contact information firm name client remittance address email and phone vendor tax id project for specific assignments stip number invoice wbs partial billing final federal aid if applicable s internal county ies description period covered rates home office overhead fccm operating margin fee amount field work completed this insert additional item numbers as needed line tracking activity multiple in total remaining billed to last subconsultant due totals supplement complete supplements rows review original different from approver or required previously list reviewed div printed approval percent approved i hereby certify that the is true correct best my knowledge has not been document sap signature pef maintains a far compliant accounting system must be su...
Related files

Share

Help

Related files

Share

Share to social media

Help

Login Area
