5-Contractors Affidavit for Payment of Debts and Claims.pdf.pdf
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- Solicitation number
- IFB-26-00075
- Issued by
- Hillsborough County, Florida
About this file
This is a Contractor's Affidavit of Payment of Debts and Claims form required by the Hillsborough County Board of County Commissioners in Florida. The affidavit serves as a certification document that contractors must complete and submit to confirm that all bills for labor, services, and materials furnished by the contractor and its suppliers and subcontractors have been paid in full or otherwise satisfied. The form requires the contractor to disclose any known indebtedness or claims for damages arising from the performance of the agreement, with exceptions to be noted if applicable. The document must be sworn to before a notary public in the State of Florida, County of Hillsborough, and includes certification fields for the date, contractor name, authorized representative, and notary information.
This affidavit is a standard contract closeout requirement associated with the LED Sports Lighting Retrofit & Installation Term Contract B for Hillsborough County Facilities Management & Real Estate Services. The affidavit would be submitted upon completion of work on the estimated $8,000,000 project, which involves the retrofit of existing metal halide sports lighting systems to LED or installation of new LED sports lighting systems at various county athletic ballfields and play courts over a four-year term. The form ensures that all financial obligations related to the contract have been resolved before final payment and contract closure.
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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 .