Dgs 30 104 form co 12 2026

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  1. Click ‘Get Form’ to open the dgs 30 104 form co 12 in the editor.
  2. Begin by entering your FEIN and Contractor name in the designated fields. This information is crucial for identification and processing.
  3. Fill in the Payment Request Number, Period Beginning Date, and Period Ending Date at the top of Part A. Ensure these dates accurately reflect the billing period.
  4. In the Schedule of Values section, input the total value of work completed to date, including original contract line items and approved change orders. Be meticulous to avoid discrepancies.
  5. Complete the Contractor Certification section by signing and typing your name. This certifies that all information provided is accurate and that you are entitled to payment.
  6. Proceed to Part B and C for Original Contract Line Items and Approved Change Orders. Fill out each line item with corresponding values, ensuring clarity on retainage percentages.

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