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Contract Statement

Date:

Construction Company

Address:

City, State, Zip

Owner:

Address:

City, State, Zip

Phone Number: _

Project name: _

Change order record:

Number of change orders to date:

Change order increase:

Change order decrease:

Net change:

Statement of contract:

Original contract amount:

Net change orders: (see above)

Adjusted contract amount:

Billing history:

Adjusted contract $ billed to date:

Less _____% retainage

Total adjusted contract less retainage:

Current invoice amount:

Less ______% retainage

Current invoice amount less retainage:

Pay this amount:

Certified By:

The undersigned certifies that to the best of his/her knowledge the work covered by this statement has been completed in accordance with the contract documents, that previous invoices were issued and the current payment shown is now due.

___________________________

__________________________

Signature