Fillable Printable VA Form 10-6001a
Fillable Printable VA Form 10-6001a
VA Form 10-6001a
CONTRACT PROGRESS REPORT
LOCATION OF PROJECT
TO
Centra Texas Health Care System (CTVHCS)
1901 Memorial Drive
Temple, TX 76504
1. PROJECT NO.2. CONTRACT NO.3. DATE CONTRACT AWARD4. DATE NOTICE TO PROCEED RECEIVED
6. NAME AND ADDRESS OF CONTRACTOR7. DESCRIPTION OF CONTRACT
12. EXTENDED CONTRACT COMPLETION DATE
ITEM
NO.
15.
VA FORM
JUN 2012
10-6001a
5. DATE CONST. STARTED
BRANCH OF WORKTOTAL VALUE
VALUE OF WORK IN
PLACE-END LAST PERIOD
VALUE OF WORK INSTALLED
IN CURRENT PERIOD
(A)(B)
(C)(D)
13. ESTIMATED COMPLETION DATE
OMB Approval No. 2900-0208
Estimated burden 12 minutes
16.
17.
18.
19.
20.
21.
22.
23.
14. DATE COMPLETED
8. ORIGINAL CONTRACT AMOUNT
9. SCHEDULED PERCENT COMPLETION
10. ACTUAL PERCENT COMPLETION
11. ORIGINAL CONTRACT COMPLETION DATE
REPORT FOR PERIOD ENDING
VA FORM
JUN 2012
10-6001a
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
SUPPLEMENTAL AGREEMENT - ADD
SUPPLEMENTAL AGREEMENT - DEDUCT
TOTAL$$$
CONTRACT FISCAL DATA
CHANGE ORDERS, SUPPLEMENTAL AGREEMENTS, AND TIME EXTENSIONS
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
55A.
55B.
55C.
55D.
56.
57.
58.
59.
60.
CURRENT CONTRACT AMOUNT (From Item 40, Col. B)
VALUE - UNUSED MATERIALS PAID FOR THIS PERIOD
RETAINAGE (Based on Item 45 less cost of bond premiums)
PAYMENT THIS PERIOD
TOTAL PAYMENT TO DATE (Item 47 plus 48)
CO CHANGE ORD., PREV. REPORTED, NO.
ISSUED THIS PERIOD
ISSUED THIS PERIOD
ISSUED THIS PERIOD
ISSUED THIS PERIOD
TOINCL.CO SUPPL. AGREE. PREV. REPORTED, SYM
TO
TO
TO
TO
INCL.
INCL.
INCL.
INCL.
51. EQUIPMENT STATUS52. MATERIALS STATUS53A. WORK PROGRESS53B. PROGRESS FACTOR54. SUBMISSIONS OVERDUE
ITEM
NO.
61. REMARKS
$
$
$
$
$
$
$
$
$
$
62. SIGNATURE OF RESIDENT ENGINEER63. DATE
ADDITIONS
DEDUCTIONS
(C)(D)(E)
DATE
APPROVED
(B)
DAYS
EXTENSION
SYMBOLS
(A)
VALUE - CONTRACT NOT EARNED (Item 41 minus 45)
VALUE - WORK IN PLACE TO DATE (Item 40, Cols. C plus D)
VALUE - UNUSED MATERIALS PREVIOUSLY PAID FOR
EARNED TO DATE (Items 42 plus 43 plus 44)
TOTAL PREVIOUS PAYMENTS
FIELD SUPPL. AGREE. PREV. REPORTED, NO.
FIELD CHANGE ORD. PREV. REPORTED, SYM.
TIME EXTENS. PREV. REPORTED, NO.
VA FORM
JUN 2012
10-6001a
The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in
accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may
not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a
valid OMB number. We anticipate that the time expended by all individuals who must complete this form will
average 12 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill
out the form. If your firm does not already have a similar form, this is used to record the data necessary to
assure the contractor provides sufficient labor and materials to accomplish the contract work. This form or a
similar document is required to guarantee the performance of the work necessary to complete the project.
