5-Contractors Affidavit for Payment of Debts and Claims.pdf.pdf
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- Attached to
- Cape Seal Pavement Preservation
- Solicitation number
- IFB-26-00111
- 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. The document serves as a certification requirement for contractors performing work on county projects. The affidavit requires the contractor to certify 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 must be completed and notarized, with the contractor attesting under oath that all known indebtedness and claims for damages arising from the performance of the contract have been resolved. The document includes spaces for noting any exceptions to full payment, the contract date, project designation, and the date of certification.
The affidavit is a standard compliance document that contractors must complete as a condition of contract performance or completion with Hillsborough County. It requires notarization by a Florida Notary Public and can be executed through either physical presence or online notarization. The form was last revised on March 6, 2020, and applies to the Cape Seal Pavement Preservation project estimated at $2,010,823.90, which involves pavement preservation work at four designated locations in Hillsborough County: Imperial Key, Wyndham Lakes Drive, Tarpon Drive, and River Close Boulevard, with potential minor milling and resurfacing operations where necessary.
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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 .