5-Subcontractors Statement of Satisfaction.pdf.pdf

PDF 118 KB Posted

Attached to
Kirby Street Pump Station #08 Rehabilitation
Solicitation number
IFB-26-00404
Issued by
Hillsborough County, Florida

About this file

This is a Subcontractor's Statement of Satisfaction form used by Hillsborough County, Florida for construction projects in the state of Florida. The form serves as an attestation that must be submitted by the General Contractor beginning with the second Application for Payment, certifying that all monies due to subcontractors for work completed in the prior payment period have been paid in full. The document requires notarization and includes fields for project identification, contractor information, payment period dates, and subcontractor confirmation of payment receipt. The form is specifically tied to Hillsborough County's construction contracting process and applies to all subcontractors whose work appeared on the preceding Application for Payment for which the General Contractor has received payment.

The Subcontractor's Statement of Satisfaction is a mandatory compliance document for the Kirby Street Pump Station #08 Rehabilitation project, a stormwater pump station construction and existing facility demolition project in Tampa, Florida with an estimated total project cost of $1,473,476.90. This form ensures transparency and accountability in the payment chain between general contractors and subcontractors, requiring sworn statements and notarization to verify that subcontractors have received full compensation for their work. The project establishes a 10% Small Business Enterprise (SBE) participation goal for subcontractor involvement, and all questions regarding the solicitation must be submitted within 14 calendar days following the site visit or pre-bid conference, whichever occurs later.

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22-Attachment C - SWFWMD ERP Permit.pdf PDF
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Subcontractors Statement of Satisfaction updated 4.9.2020

SUBCONTRACTOR'S STATEMENT OF SATISFACTION

(Attachment to General Contractor's Application for Payment No. )

Note: The General Contractor shall attach this statement to each Application for Payment beginning with the second Application for Payment. This statement is applicable to each subcontractor whose work appeared on the prior Application for Payment for which the General Contractor has been paid.

KNOW ALL MEN BY THESE PRESENTS, That, (Name) representing whose address is with the title of , who after being first duly sworn, upon oath, deposes and says that pursuant to the provisions of the contract for:

Project No.

Project Name:

General Contractor:

that all monies due him/her from the General Contractor's Application for Payment No.

(Period of work: to ) have been paid to him/her.

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 ___________, 20___, 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 ______________________

File details come from the government source that posted it. Updated .