City of Overland Park

CERTIFICATE OF SUBCONTRACT

WORK AND PAYMENT

I certify that	received payment from the City of Overland Park on	and, within 10 days after this date, paid the subcontractors named below for the work those subcontractors completed on or before the payment voucher’s “Paid to Date”.

Project No.

Subcontractors Paid:	Dollar Amount Paid:

$

$

$

$

$

$

(Contractor)

(Date)

(Date)

(Signature of Contractor or Representative)

CERTIFICATE OF SUBCONTRACT WORK AND PAYMENT

Joe Archer

2001-12-31

jnclark

City of Overland Park