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

This is a Contractor's Affidavit of Payment of Debts and Claims form required by the Hillsborough County Board of County Commissioners in Florida for the Pipeline Work Order Construction Services project (WORCs 6). The affidavit serves as a certification document that contractors must complete and have notarized, confirming that all bills for labor, services, and materials furnished by the contractor and its suppliers or subcontractors have been paid in full or otherwise satisfied. The form requires the contractor to identify any exceptions to full payment and includes spaces for the contract date, project designation, contractor name, and signature by an authorized representative. The document must be sworn to or affirmed before a notary public and includes sections to indicate whether notarization occurred through physical presence or online means.

The Pipeline Work Order Construction Services contract opportunity is valued at approximately $12,075,000.00 and requires qualified contractors to provide construction and installation services for water mains, reclaimed water mains, and wastewater force mains, along with miscellaneous installations and modifications at various Hillsborough County Water Resources Department facilities, pumping stations, and equipment. The solicitation establishes a 6% Small Business Enterprise (SBE) participation goal for subcontractors. Contractors must submit the completed affidavit as part of the contracting process, demonstrating financial responsibility and satisfactory payment of all project-related obligations before final contract closeout.