WORK ORDER/ORDEN DE TRABAJO Date/fecha: ________________________________________________ Contractor/contratista: ________________________________________ ❑ ❒ ❒ ❒ 01 25 63 99 ❒ 02 ❒ 26 ❒ 67 ❒ 08 ❒ 27 ❒ 71 ❒ 10 ❒ 28 ❒ 76 ❒ 11 ❒ 29 ❒ 77 ❒ 13 ❒ 30 ❒ 80 ❒ 14 ❒ 31 ❒ 84 ❒ 15 ❒ 34 ❒ 88 ❒ 16 ❒ 35 ❒ 90 ❒ 17 ❒ 41 ❒ 94 ❒ 21 ❒ 43 ❒ 96 ❒ 22 ❒ 45 ❒ 97 ❒ 23 ❒ 56 ❒ 98 SPECIFICATIONS/ESPECIFICACIONES Cost / costo _____________________________________________________________________ __________________ _____________________________________________________________________ __________________ _____________________________________________________________________ __________________ _____________________________________________________________________ __________________ _____________________________________________________________________ __________________ _____________________________________________________________________ __________________ _____________________________________________________________________ __________________ _________________________________ Signature/Firma Name: ___________________________ Proof of satisfaction/prueba de satisfacción ❒ Satisfactorily completed work/trabajo completado satisfactoriamente. ❒ Uncompleted/incompleto. Pending/pendiente: ___________________________ ____________________________________________________________________ Date/fecha: _______________________ ______________________________ Signature /Firma Name: ________________________ (This form have to be fully filled and signed, at the time of requesting the payment / Este modelo debe ser completamente llenado y firmado para presentar con su solicitud de pago)