5-Subcontractors Statement of Satisfaction.pdf.pdf

PDF 118 KB Posted

Attached to
CR 584 (Waters Ave) at Florida Mining Blvd. Intersection Improvements
Solicitation number
IFB-26-00287
Issued by
Hillsborough County, Florida

About this file

This is a Subcontractor's Statement of Satisfaction form prepared for Hillsborough County, Florida in connection with the CR 584 (Waters Ave) at Florida Mining Boulevard Intersection Improvements project. The form serves as an attestation document that general contractors must attach to each Application for Payment beginning with the second submission. The statement confirms that all monies due to subcontractors from the prior Application for Payment have been paid in full. The form requires notarization in Hillsborough County, Florida and includes fields for the subcontractor's name, address, title, project number, project name, general contractor identification, application period, and notarization details including the notary public's commission information and identification requirements.

The Subcontractor's Statement of Satisfaction is a mandatory compliance document within the payment process for the CR 584 intersection improvements project, which involves the installation of a new traffic signal with two mast arm structures estimated at $2,582,238.00. This form ensures contractor accountability and payment transparency throughout the project duration. The solicitation establishes a 7% Small Business Enterprise (SBE) subcontractor participation goal. The document reflects standard construction contracting procedures in Florida, requiring sworn statements and notarization to verify that subcontractors have received full payment before general contractors can receive subsequent payment applications.

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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 .