5-Contractors Affidavit for Payment of Debts and Claims.pdf.pdf
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- Solicitation number
- IFB-26-00005
- Issued by
- Hillsborough County, St. Petersburg City, Florida
About this file
This document is a Contractor's Affidavit of Payment of Debts and Claims issued by Hillsborough County Board of County Commissioners in the State of Florida. The form is designed to certify that all bills for labor, services, and materials related to a specific project have been paid in full, including all known indebtedness and claims for damages that might potentially involve the county's responsibility.
The form requires the contractor to complete details about the specific agreement, including the date of the agreement, the project designation, and any exceptions to full payment. It provides a notarization section to be completed in Hillsborough County, Florida, with options for physical presence or online notarization. The document was revised on 03.06.2020 and includes spaces for the contractor's signature, title, and details about identification or personal knowledge of the signatory.
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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 ___________, 2020, 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 ______________________
Revised 03.06.2020
CONTRACTOR’S AFFIDAVIT OF
File details come from the government source that posted it. Updated .