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 Pink Indicates area for data entry. Automatic calculation. Enter amount to override normal fee (requires prior approval).
Tab Directory Tab #1 Tab #2 Tab #3 Tab #4 Tab #5 Tab #6 Tab #7 Tab #8 Tab Instructions Tab #2 A - Summary Instructions; 3 pages A - Summary; 1 page B - Detail Sheet; 1 page C - Original Contract; 1 page D - Amendments; 21 pages E - Change Order Fee Allowance; 25 pages F - EDGE ; 2 pages G - Upload; 3 pages
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. Purchase Order # Request No. Project Name A/E Phone No. A/E Fax No. A/E FTID (hidden) A/E E-mail A
Service Category
A - Summary
Sheet
1
of
3
For the period Project Location from to B C
Original
D
E
Amended
F
G
H
I
J
K
Amount Due
L
Bal. Avail.
Agreement Information Previously Billed Completed to Date
%
Basic Services Additional Services Reimbursable Expenses Totals
$
%
$
%
$
%
$
%
$
$
Architect/Engineer Certification
The A/E certifies it has provided the services indicated above and acknowledges its responsibility to render all payments to those to which it is obligated relative to the A/E Agreement, all in accordance with the A/E Agreement.
University Authorization
The University acknowledges this request for payment, agrees that the amount requested is a fair and reasonable request for the services provided to date, and authorizes the release of funds for this payment request.
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 Project Name UC Project No. Purchase Order #
B - Detail Sheet
Request No. Sheet 2 of 3
Service Category 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
Original Amount
Amended
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
C - Original Agreement
Request No. Sheet 3 of 3
Original Services 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
Original Amount
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 4 of 3
Amendment No. 1 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 5 of 3
Amendment No. 2 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 6 of 3
Amendment No. 3 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 7 of 3
Amendment No. 4 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 8 of 3
Amendment No. 5 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 9 of 3
Amendment No. 6 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 10 of 3
Amendment No. 7 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 11 of 3
Amendment No. 8 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 12 of 3
Amendment No. 9 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 13 of 3
Amendment No. 10 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 14 of 3
Amendment No. 11 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 15 of 3
Amendment No. 12 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 16 of 3
Amendment No. 13 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 17 of 3
Amendment No. 14 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 18 of 3
Amendment No. 15 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 19 of 3
Amendment No. 16 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 20 of 3
Amendment No. 17 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 21 of 3
Amendment No. 18 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 22 of 3
Amendment No. 19 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 23 of 3
Amendment No. 20 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
D - Amendments
Request No. Sheet 24 of 3
Amendment No. 21 Services 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
Amendment
Previously Billed
Completed To Date
Amount Due
Balance Available
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 4 of 3
Change Order Fee %
Change Order Fee Allowance Source Amount Original Contract
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
Current Total Used to Date
Remaining Allowance
SAO-F110-01v1108, ADM-5828
Total This Sheet
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 5 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 6 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 7 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
e. Amounts Billed Previous Current
d.
f. 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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 8 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
e. Amounts Billed Previous Current
d.
f. 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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 9 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 10 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 11 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 12 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 13 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 14 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 15 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 16 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 17 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 18 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 19 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 20 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 21 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 22 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 23 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 24 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 25 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 26 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 27 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order #
E - Change Order Fee Allowance
Request No. Sheet 28 of 3
Change Order Fee %
a. Change Order Number
b. Change Order Amount
c. Change Order Fee
d.
e.
f. Balance
Amounts Billed Previous Current
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 Project Name UC Project No. Purchase Order # Sheet
F - EDGE
Request No. 4 of 3
Reference
Projected EBE FTID EDGE-certified Business Enterprise (EBE) Name (hidden) Award Date Start Date
Projected End Date
Actual Start Date
Actual End Date Contract Amount Payments To Date Status (enter "X") 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 Project Name
UC Project No. Purchase Order # Request No.
G - Upload
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 Projected Start Date Projected End Date Actual Start Date Actual End Date Estimated Total Cost Of Contract Status None None None None None None None None None None None None None None None None None
Type
Name
Tax ID
Award Date
Payments To Date
A B C D E F G H I J K L M N O P Q
S S S S S S S S S S S S S S S S S
R S T U V W X Y Z
S S S S S S S S S
None None None None None None None None None