12-Contractors Affidavit for Payment of Debts and Claims 02.18.2026.pdf
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- Solicitation number
- IFB-26-00401
- Issued by
- Hillsborough County, Florida
About this file
This is a Contractor's Affidavit of Payment of Debts and Claims form used by the Hillsborough County Board of County Commissioners in Florida for the R3M Miscellaneous Facilities Construction Term Contract 11. The affidavit certifies that the contractor has paid all bills for labor, services, and materials furnished by the contractor and its suppliers and subcontractors under the project agreement, and that all known indebtedness and claims for damages arising from contract performance have been satisfied. The form requires the contractor to identify any exceptions to full payment, provides spaces for the agreement date, project designation, contractor name, and contractor signature with title, and must be notarized by a Florida Notary Public with specification of whether the signer was personally known or produced identification.
The affidavit is a completion document required as part of the contracting process for miscellaneous facilities construction projects with an estimated value of $16,500,000.00. The contract involves the Hillsborough County Facilities Management and Real Estate Services Department and covers interior and exterior building repairs and renovations, re-roofing, site work, utilities, landscaping, and electrical, mechanical, and plumbing work. A 10% Small Business Enterprise (SBE) subcontractor participation goal has been established for this solicitation and its resulting contract.
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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 .