12-Contractors Affidavit for Payment of Debts and Claims 02.18.2026.pdf

PDF 543 KB Posted

Attached to
CR 584 (Waters Ave) at Florida Mining Blvd. Intersection Improvements
Solicitation number
IFB-26-00287
Issued by
Hillsborough County, Florida

About this file

This is a Contractor's Affidavit of Payment of Debts and Claims document associated with Hillsborough County Board of County Commissioners for the CR 584 (Waters Ave) at Florida Mining Boulevard Intersection Improvements project. The affidavit serves as a certification requirement whereby the contractor must attest that all bills for labor, services, and materials furnished by the contractor and its suppliers and subcontractors have been paid in full or otherwise satisfied, including all known indebtedness and claims for damages arising from performance of the agreement. The document must be completed by the contractor, executed with the contractor's signature and title, notarized before a Florida notary public, and submitted to the County. The affidavit includes provisions for the contractor to note any exceptions to full payment, with space to attach supporting documentation if exceptions exist.

The affidavit functions as a required closeout document for the intersection improvements project valued at $2,582,238.00, which involves installation of traffic signals, roadway widening and resurfacing, drainage improvements, and sidewalk reconstruction across 0.230 miles. The document must be completed upon substantial or final project completion, establishing contractor accountability for all financial obligations related to the contract performance. Submission of this affidavit is a standard requirement for contract closeout with Hillsborough County and serves to protect the County by ensuring no outstanding claims or liens remain unresolved before final payment and project acceptance.

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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 .