34-Doc 00 65 19.13 - Contractors Affidavit.pdf
PDF 68 KB Posted
- Attached to
- 2201256.01 - Whistlestop Park
- Solicitation number
- US.160528
- Issued by
- Montgomery County, Pennsylvania
About this file
This is a Contractor's Affidavit form related to Contract 2022-01256.01 for Whistlestop Park, a project between Montgomery Township, located at 1001 Stump Road, Montgomeryville, PA 18936-9605, and its contractor. The affidavit serves as a sworn statement certifying that all labor, materials, outstanding claims, and indebtedness arising from the performance of work, including all approved change orders under the agreement, have been satisfied and paid in full. The document requires completion by an individual, partner, or duly authorized representative of the contractor and must be notarized before a Notary Public in the relevant county and state. The affidavit includes spaces for the contractor's company name, signature, and the date of sworn testimony, along with the notary's signature and the date of notarization.
The Whistlestop Park project involves the rehabilitation of a softball field, construction of perimeter fencing for a new playground, pickleball courts, a loop trail, stormwater basins, and associated landscaping at the Montgomery Township facility. The bid submission deadline is April 30, 2026 at 10:00 AM via PennBid, with bids to be publicly opened and read aloud at the township offices. The successful bidder is required to submit Performance and Payment Bonds each in the amount of 100% of the contract amount and a Maintenance Bond equal to 15% of the contract award price, in addition to a 10% Bid Bond. The project is subject to Pennsylvania Prevailing Wage Act (Act 422) and Public Works Employment Verification (Act 127) requirements. All bids remain subject to acceptance for sixty days after the bid opening, with withdrawal permitted only within two business days of opening.
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Text version
CONTRACTOR'S AFFIDAVIT
00 65 19.13-1
DOCUMENT 00 65 19.13
CONTRACTOR'S AFFIDAVIT
STATE OF______________________________:
COUNTY OF ____________________________:
Before me, the undersigned, a Notary Public in and for said County and State personally appeared
( Individual/Partner/Duly Authorized Representative of Corporate Contractor ) who being duly sworn according to law deposes and says that all labor, material and outstanding claims and indebtedness of whatever nature arising out of the performance of the Work including all approved change orders under an Agreement dated _______________________, 20___ associated with
Contract 2022-01256.01: Montgomery Township – Whistlestop Park
Between Montgomery Township, 1001 Stump Road, Montgomeryville, PA 18936-9605 (Owner, Name and Address) and________________________________________________________________________________ (Contractor, Name and Address) have been satisfied and paid in full.
CONTRACTOR
Company:
(Corp. Seal) Signature:_________________________________ (Individual, Partner or Duly Authorized Representative of Corporate Contractor)
Name and Title:
Sworn and subscribed before me this
_____day of ________________,20___.
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