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[]
[]
[null,null,null,"STATE OF MONTANA",null,null,null,null,null,null,null,"DMA#:",""]
[null,null,null,"DEPARTMENT OF MILITARY AFFAIRS",null,null,null,null,null,null,null,"Date:"]
[null,null,null,"CONSTRUCTION AND FACILITIES MANAGEMENT OFFICE",null,null,null,null,null,null,null,"Pay Estimate:"]
[null,null,null,"1956 Mt. Majo St. • P.O. Box 4789 • Fort Harrison, MT 59636-4789 ",null,null,null,null,null,null,null,"Period From:"]
[null,null,null,"Phone: 406 324-3100 • Fax: 406 449-5148",null,null,null,null,null,null,null,"To:"]
[]
[null,null,null,"PERIODIC ESTIMATE FOR PARTIAL PAYMENT"]
[]
["Project Name:",null,null,null,null,null,"Contractor:"]
[null,"Location:",null,null,null,null,"Address:",null,""]
[null,null,null,null,null,null,"Phone:",null,"","E-mail:",""]
[]
["RETAINAGE ADJUSTMENT",null,null,null,null,null,null,"CONTRACT AMOUNT STATUS"]
["1. Total Retainage to Date:",null,null,null,null,{"$f":"'WIP Page 2'!N38","v":0},null,"1. Orginal Contract Amount:"]
["2. Less Securities Deposited or Retainage Paid Out:",null,null,null,null,null,null,"2. Net +/- Change Order",null,"(Pulls from Change Order Summary)",null,null,{"$f":"F28","v":0}]
["3. Retainage Withheld (1-2)",null,null,null,null,{"$f":"F16-F17","v":0},null,"3. Contract Amount to Date:",null,null,null,null,{"$f":"SUM(M16:N17)","v":0}]
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["CHANGE ORDER SUMMARY",null,null,null,null,null,null,"CONTRACT STATUS"]
["No.","Date Approved",null,"Additions",null,"Deductions",null,"1. Work in Place (from next page)    (Col D+E Total - Grand Totals Page 2)",null,null,null,null,{"$f":"'WIP Page 2'!I38+'WIP Page 2'!H38","v":0}]
[null,null,null,null,null,null,null,"2. Total Work & Stored Material:",null,null,null,null,{"$f":"'WIP Page 2'!K38","v":0}]
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[null,null,null,null,null,null,null,"4. Total Earned Less Retainage:",null,null,null,null,{"$f":"M22-M23","v":0}]
[null,null,null,null,null,null,null,"5. Less Previous Payments(+ 1 % Tax):",null,null,null,null,{"$f":"'WIP Page 2'!H38-('WIP Page 2'!H38*0.05)","v":0}]
[null,null,null,null,null,null,null,"6. Amount Due This Payment:",null,null,null,null,{"$f":"M24-M25","v":0}]
["TOTALS:",null,null,{"$f":"SUM(D22:E26)","v":0},null,{"$f":"SUM(F22:F26)","v":0},null,"7. Less 1% State Contractor's Tax:",null,null,null,null,{"$f":"0.01*M26","v":0}]
["NET TOTAL:",null,null,null,null,{"$f":"D27-F27","v":0},null,"8. Payment Due Contractor:",null,null,null,null,{"$f":"M26-M27","v":0}]
[]
["I hereby certify that this submitted request for payment is correct, thru and just in all respects and that payment or credit has not previously been received. I future warrant and certify by submission of this request that all previous work for which payment has been  received is free and clear of all liens, disputes, claims, security interest, encumbrances, or causes of action of any type or kink in favor of the contractor, subcontractors, material suppliers, or other persons or entities and do hereby release the owner from such."]
[]
["Submitted by:",null,null,null,null,null,null,null,null,null,null,"Date:"]
[null,null,"(Company /Contractor)",null,null,null,null,"(Name)"]
["Reviewed by:",null,null,null,null,null,null,null,null,null,null,"Date:"]
[null,null,"(Architect/Engineer)",null,null,null,null,"(Name)"]
["Approved by:",null,"Montana Dept. of Military Affairs",null,null,null,null,null,null,null,null,"Date:"]
[null,null,"Construction and Facilities Management Office",null,null,null,null,"(Name)"]

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[]
["Attach additional sheets as needed.  "]

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[]
["Attach additional sheets as needed.  "]

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["WORK IN PLACE / STORED MATERIALS"]
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[]
["Attach additional sheets as needed.  "]