5-Contractors Affidavit for Payment of Debts and Claims.pdf.pdf
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- Solicitation number
- IFB-26-00085
- Issued by
- Hillsborough County, Florida
About this file
This is a Contractor's Affidavit of Payment of Debts and Claims form issued by the Hillsborough County Board of County Commissioners in Florida for the Lenwood Lane/1st Avenue NW/4th Avenue SE Culvert Replacements project. 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 performance of the contract have been satisfied. The form requires the contractor to identify any exceptions to full payment and provides space for notarization by a Florida notary public. The culvert replacement project encompasses three locations: 12026 Lenwood Lane (CIP 46142452), 111 1st Avenue NW (CIP 46142473), and 303 4th Street SE (CIP 46142490), with an estimated project value of $1,958,866.12.
The solicitation for this infrastructure improvement project was issued by Hillsborough County Engineering and Operations Department as a competitive sealed bid opportunity. A Small Business Enterprise (SBE) subcontractor goal of 6% has been established for the contract. Contractors must submit questions and requests for interpretation no later than 14 calendar days after the date of solicitation issuance, site visit, or pre-bid conference, whichever occurs later, as specified in Paragraph 4.7 of the Contract Terms and Conditions Document.
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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 .