Instructions for the Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
General Information
The Architect/Engineer (A/E) Payment Request workbook was created in Microsoft Excel 2003, SP3. The entire
document is comprised of 8 worksheet tabs. In 2 of the tabs (D and E) there are multiple pages. Please review the
entire document before starting. While every project uses each tab, all pages within the tabs are not necessarily used
on each project. In other words, use all of the tabs for the project and use only the actual number of pages required for
your specific project.
Prior to submitting the first request for any project, complete the A/E Payment Request based on the A/E Agreement
and submit it to the Contracting Authority for review and acceptance.
We strongly encourage that the A/E keep a separate electronic file of their initial submittal and each subsequent
Payment Request.
Legend
Many cells within the document are protected from changes or entries. In general, the following legend will help the
user to quickly identify cells that are available for data entry.
Yellow Indicates area for data entry.
Pink Automatic calculation. Enter amount to override normal fee (requires prior approval).
Tab Directory
Tab #1 Instructions; 3 pages
Tab #2 A - Summary; 1 page
Tab #3 B - Detail Sheet; 1 page
Tab #4 C - Original Contract; 1 page
Tab #5 D - Amendments; 21 pages
Tab #6 E - Change Order Fee Allowance; 25 pages
Tab #7 F - EDGE ; 2 pages
Tab #8 G - Upload; 3 pages
Tab Instructions
Tab #2 A - Summary
In the yellow cells, insert the name, address, phone numbers, tax identification, e-mail address, project number, project
name and project location. This is the only location that this information needs to be entered.
In the blue cells, insert the local number, if any, as assigned or determined by the Owner. Consult the Owner for local
numbers required.
All payment data will compute and summarize to this worksheet with no manual entries.
After the initial form for each project has been reviewed, approved, and returned from the Contracting Authority, the
A/E will use the approved information for all future payment requests Each monthly request will require a new
payment request number and an update of the payment request information for that period. Drafts of each request may
be e-mailed to the Contracting Authority and others for review and comment.
After each payment request with blue ink has been reviewed and is ready for final submittal, save the document, then
print it for signature and distribution.
SAO-F110-01v1108, ADM-5828 Instructions, Page 1 of 3
Instructions for the Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
Tab #2 A - Summary (continued)
Please sign and date each monthly request on this page. Original signatures are required on all copies.
Tab #3 B - Detail Sheet
No manual entries are recorded on this worksheet. The primary purpose of this worksheet is to summarize the
Original Contract with Amendments.
Tab #4 C - Original Contract
The A/E name, project name, project number, local number and invoice number will fill-in automatically and match
the information completed from the summary worksheet.
Complete the "Contract" column with the dollar amounts of the Basic Services from the Original Contract. Fill in the
dollar amounts for the Contract Change Order Fee Allowance for Basic Services.
List all Additional Services, if any, as part of the Contract. List them and the associated dollar amount individually
starting in item "b".
Complete the "Contract" column for Reimbursables for Bid Printing and Permits. List all other contracted
reimbursables and the associated dollar amount starting with item "c".
The Contract dollar amounts will total as they are entered and will carry forward to "A - Summary" and "B - Detail
Sheet" Worksheets.
Tab #5 D - Amendments
There are multiple pages to the Amendment Worksheet. Enter all Amendments on this worksheet. Use only one page
for each Amendment. Enter Amendment #1 to the A/E Agreement on Page 1; Amendment #2 to the A/E Agreement
on Page 2, and so on.
Enter the approved Amendment dollar amount in the applicable row. Please enter only the dollar amounts for one
Amendment per page even though there might be an available cell in a previous Amendment page. Enter each
Amendment on a separate page within the Tab #5, "D - Amendment" Worksheet.
The totals of all Amendments will carry forward to the "A - Summary" and "B - Detail Sheet" Worksheets
automatically as entered.
Important Note: When printing this worksheet, print ONLY the pages used and the pages that have entries made on
them. Do this in the "print" feature in MS Excel.
Tab #6 E - Change Order Fee Allowance
In addition to the names and numbers carrying forward to this sheet, the approved Change Order Fee Allowances from
the Original Contract and the Amendments will automatically carry forward to the pages in the first two grey columns.
Enter the percentage of the Original Contract Change Order Fee % in the top center space.
As Change Orders are authorized, enter the Change Order Number and the approved Contractor's dollar amount in the
Change Order amount column. The worksheet will automatically calculate the associated Change Order Fee and carry
it forward to the "A - Summary" and "B - Detail Sheet" worksheets.
Please note there are 25 pages to the Change Order Fee Allowance Worksheet. As with "D - Amendments", print and
send only the pages with entries.
SAO-F110-01v1108, ADM-5828 Instructions, Page 2 of 3
Instructions for the Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
Tab #6 E - Change Order Fee Allowance (continued)
Please consult with your project manager or project coordinator prior to modifying these cells.
Tab #7 F - EDGE
Fill out Tab F - EDGE completely to include all EDGE consultants expected to be used.
Tab #8 G - Upload
Tab G pulls data from other locations within the file - Do not enter data in this worksheet. This worksheet is used to
upload data into the Contract Tracking System application.
SAO-F110-01v1207, ADM-5828 Instructions, Page 3 of 3
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
Architect/Engineer (A/E) Name & Address UC Project No. A - Summary
Purchase Order #
Request No.
Project Name Sheet 1 of 3
A/E Phone No.
A/E Fax No. For the period
A/E FTID (hidden) Project Location from
A/E E-mail to
A B C D E F G H I J K L
Service Category Agreement Information
Original Amended Previously Billed Completed to Date Amount Due Bal. Avail.
% $ % $ % $ % $ % $ $
Basic Services
Additional Services
Reimbursable Expenses
Totals
Architect/Engineer Certification University Authorization
The A/E certifies it has provided the services The University acknowledges this request for
indicated above and acknowledges its payment, agrees that the amount requested is a fair
responsibility to render all payments to those to and reasonable request for the services provided to
which it is obligated relative to the A/E date, and authorizes the release of funds for this
Agreement, all in accordance with the A/E payment request.
Agreement.
Name/Title (typed or printed) Name/Title (typed or printed)
Signature Date Signature Date
SAO-F110-01v1108, ADM-5828 Section A - Summary, Page 1 of 1
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. B - Detail Sheet
Project Name Purchase Order # Request No.
Sheet 2 of 3
Service Category Original Amount Amended Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allow.
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Totals
SAO-F110-01v1108, ADM-5828 Section B - Details Page, 1 of 1
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. C - Original Agreement
Project Name Purchase Order # Request No.
Sheet 3 of 3
Original Services Original Amount Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Original Contract
SAO-F110-01v1108, ADM-5828 Section C - Original Contract, Page 1 of 1
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 4 of 3
Amendment No. 1 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 1
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 1 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 5 of 3
Amendment No. 2 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 2
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 2 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 6 of 3
Amendment No. 3 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 3
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 3 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 7 of 3
Amendment No. 4 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 4
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 4 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 8 of 3
Amendment No. 5 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 5
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 5 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 9 of 3
Amendment No. 6 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 6
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 6 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 10 of 3
Amendment No. 7 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 7
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 7 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 11 of 3
Amendment No. 8 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 8
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 8 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 12 of 3
Amendment No. 9 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 9
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 9 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 13 of 3
Amendment No. 10 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 10
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 10 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 14 of 3
Amendment No. 11 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 11
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 11 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 15 of 3
Amendment No. 12 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 12
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 12 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 16 of 3
Amendment No. 13 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 13
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 13 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 17 of 3
Amendment No. 14 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 14
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 14 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 18 of 3
Amendment No. 15 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 15
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 15 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 19 of 3
Amendment No. 16 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 16
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 16 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 20 of 3
Amendment No. 17 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 17
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 17 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 21 of 3
Amendment No. 18 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 18
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 18 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 22 of 3
Amendment No. 19 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 19
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 19 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 23 of 3
Amendment No. 20 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 20
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 20 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. D - Amendments
Project Name Purchase Order # Request No.
Sheet 24 of 3
Amendment No. 21 Services Amendment Previously Billed Completed To Date Amount Due Balance Available
Basic Services
Pre-Design
Schematic Design
Design Development
Construction Documents
Bidding & Award
Conformed Documents
Construction Administration
Project Closeout
Subtotal (A)
Additional Services
a Change Order Fee Allowance
b
c
d
e
f
g
h
i
j
Subtotal (B)
Reimbursable Expenses
a Bid Printing
b State Permits
c
d
e
f
g
Subtotal (C)
Total Amendment No. 21
SAO-F110-01v1108, ADM-5828 Section D - Amendments, Page 21 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 4 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Change Order Fee Allowance Number Amount Fee Previous Current Balance
Source Amount
Original Contract
Current Total
Used to Date
Remaining Total This Sheet
Allowance
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 1 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 5 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 2 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 6 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 3 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 7 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 4 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 8 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 5 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 9 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 6 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 10 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 7 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 11 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 8 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 12 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 9 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 13 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 10 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 14 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 11 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 15 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 12 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 16 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 13 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 17 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 14 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 18 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 15 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 19 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 16 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 20 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 17 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 21 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 18 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 22 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 19 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 23 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 20 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 24 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 21 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 25 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 22 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 26 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 23 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 27 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 24 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. E - Change Order
Project Name Purchase Order # Fee Allowance
Request No.
Change Order Fee % Sheet 28 of 3
a. b. c. d. e. f.
Change Order Change Order Change Order Amounts Billed
Number Amount Fee Previous Current Balance
Total This Sheet
Grand Total
SAO-F110-01v1108, ADM-5828 Section E - Change Order Fee Allowance, Page 25 of 0
Architect/Engineer Payment Request
Division of Administration and Finance
Planning + Design + Construction
PO Box 210186 ▪ Cincinnati, Ohio 45221-0186
A/E Name UC Project No. F - EDGE
Project Name Purchase Order # Request No.
Sheet 4 of 3
Reference
Projected Projected Actual Actual
EBE FTID Award Start End Start End Contract Payments Status (enter "X")
EDGE-certified Business Enterprise (EBE) Name (hidden) Date Date Date Date Date Amount To Date Active Complete Void
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
SAO-F110-01v1108, ADM-5828 Section F - EDGE, Page 1 of 1
A/E Name UC Project No. G - Upload
Project Name
Purchase Order # Request No.
Data for Upload to Capital Improvement Projects Tracking System
Project
Project Number
Local Project Number
Project Name
EDGE Waiver
Agency
Address
City
State
Zip Code
County
Projected Start Date
Projected End Date
Actual Start Date
Actual End Date
Estimated Total Cost
Project Status
Original EDGE Goal Percent
Revised EDGE Goal Percent
Comments
A/E (Type A)
Contract Number
Local Contract Number
Contract Type
Contract Method
EDGE Waiver
Contract or Subcontract
Award Date
Projected Start Date
Projected End Date
Actual Start Date
Actual End Date
Estimated Total Cost
Payments to Date
Payment Request Number
Date A/E Signed
Date Owner Authorization
SAO/Agency Approval Date
As of Date
Contract Status
Original EDGE Goal Percent
Revised EDGE Goal Percent
Vendor FTID
Vendor Name
Vendor Address
Vendor City
Vendor State
Vendor Zip Code
Vendor County
Vendor Phone
Vendor Email
Comments
Sub/Supplier Data (Type S)
Reference
Status
Projected Projected Actual Actual Estimated
Type
Award Start End Start End Total Cost Payments
Name Tax ID Date Date Date Date Date Of Contract To Date
A S None
B S None
C S None
D S None
E S None
F S None
G S None
H S None
I S None
J S None
K S None
L S None
M S None
N S None
O S None
P S None
Q S None
R S None
S S None
T S None
U S None
V S None
W S None
X S None
Y S None
Z S None