12-Contractors Affidavit for Payment of Debts and Claims 02.18.2026.pdf
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- Attached to
- Kirby Street Pump Station #08 Rehabilitation
- Solicitation number
- IFB-26-00404
- Issued by
- Hillsborough County, Florida
About this file
This is a Contractor's Affidavit of Payment of Debts and Claims form required by Hillsborough County Board of County Commissioners for the Kirby Street Pump Station #08 Rehabilitation project in Tampa, Florida. The affidavit serves as a certification document that contractors must complete and notarize to confirm that all bills for labor, services, and materials furnished by the contractor and all suppliers and subcontractors have been paid in full or otherwise satisfied. The form requires the contractor to disclose any exceptions or outstanding indebtedness and claims for damages arising from performance of the contract. The document must be sworn to before a Florida notary public and includes fields for the agreement date, contractor name, project designation, certification date, contractor signature, and notary information.
The affidavit is a standard compliance requirement for contract closure with Hillsborough County and must be executed by authorized contractor representatives. The form allows contractors to note exceptions if all debts and claims have not been satisfied, requiring attachment of a detailed list if applicable. This document is typically submitted as a condition of final payment and contract completion for the Kirby Street Pump Station #08 Rehabilitation project, which has an estimated total project cost of $1,473,476.90 and includes a 10% Small Business Enterprise (SBE) subcontractor participation goal.
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Text version
CONTRACTOR’S AFFIDAVIT OF
PAYMENT OF DEBTS AND CLAIMS
The undersigned hereby certifies that except as noted below all bills for labor, services and materials furnished by the CONTRACTOR and all suppliers and/or subcontractors of the CONTRACTOR under and pursuant to the provisions of the Agreement dated the ________ day of _______________, 20_____, between the Hillsborough County Board of County Commissioners (COUNTY) and _________________________________________ (CONTRACTOR) concerning that certain project designated as __________________________________________________________ have been paid in full or otherwise satisfied including all known indebtedness and all claims for damages against said CONTRACTOR arising in any manner in connection with the performance of the Agreement referenced above for which the COUNTY might in any way be held responsible.
Exceptions: ________ (If none, write “None”.)
__________ (If yes, write “Yes” and attach list.)
Certified this ________ day of _________________, 20 ______.
CONTRACTOR:
BY:
Title
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
Sworn to (or affirmed) and subscribed before me by means of physical presence or online notarization, this ____ day of ___________, 20__, by____________________________, (Name of person making statement)
(Signature of Notary Public - State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known or Produced Identification
Type of Identification Produced ______________________
File details come from the government source that posted it. Updated .