Design a progress payment form that could be used with the unit-price contract whose unit price schedule is shown in Table 4.4. Assume the following quantities have been completed as of the end of the month for which payment is sought: clearing and grubbing, 0.75;

unclassified excavation, 13 050; borrow, 24 670; aggregate base course, 2500; aggregate surface course, 665; 300 mm corrugated steel pipe, 85; 500 mm corrugated steel pipe, 172.

The retainage percentage is 10%, and the amount paid through the end of the previous month is US$ 553 275. Complete the form, and show the amount the contractor will be paid, assuming the request for payment is approved.