14-Contractors Affidavit for Payment of Debts and Claims 02.18.2026.pdf
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- Solicitation number
- IFB-26-00363
- Issued by
- Hillsborough County, Florida
About this file
This is a Contractor's Affidavit of Payment of Debts and Claims form for the Hillsborough County Board of County Commissioners in Florida. The affidavit certifies that a contractor has paid all bills for labor, services, and materials furnished under a specific agreement with the county, including payments to all suppliers and subcontractors. The form documents that all indebtedness and claims for damages arising from the contract performance have been satisfied or otherwise resolved. The contractor must complete the affidavit by indicating the agreement date, project designation, and listing any exceptions to full payment. The document requires notarization by a Florida notary public and must be sworn to or affirmed by an authorized representative of the contractor.
This affidavit is associated with the Roadway Resurfacing Repair and Preservation Districts 3 & 4 project, a $16,000,000 estimated-cost contract requiring roadway resurfacing, preservation, and repair services throughout Hillsborough County Districts 3 and 4. Work includes milling, resurfacing with Superpave Asphaltic Concrete, preservation treatments, and Full Depth Reclamation methods. The contract includes a 5% Small Business Enterprise (SBE) subcontractor participation goal. The affidavit serves as a final documentation requirement confirming the contractor's satisfaction of all financial obligations related to the contract upon completion or closeout.
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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 .