6-Subcontractors Statement of Satisfaction.pdf.pdf

PDF 118 KB Posted

Attached to
Bearss Ave at Florida Ave Intersection Improvements
Solicitation number
IFB-26-00354
Issued by
Hillsborough County, Florida

About this file

This is a Subcontractor's Statement of Satisfaction form used by Hillsborough County, Florida for construction payment applications. The document serves as an attestation from subcontractors confirming that all monies owed to them by the General Contractor for work completed during a specific billing period have been paid in full. The statement must be notarized and attached to each Application for Payment beginning with the second payment request. The form requires completion with project details including the Project Number, Project Name, General Contractor identification, Application for Payment Number, and the work period covered. For the related project, Bearss Avenue at Florida Avenue Intersection Improvements, the estimated contract value is $1,263,856.86 and includes roadway widening for an exclusive westbound to southbound right turn lane, milling and resurfacing, drainage improvements, Americans with Disabilities Act sidewalk and pedestrian curb ramp improvements, earthwork, traffic signal installation with pedestrian features, and signing and pavement marking.

The notarization requirement specifies that the statement must be sworn before a Florida Notary Public either through physical presence or online notarization. The subcontractor making the statement must be identified with their legal name, address, and title, and the notary public must document whether the individual was personally known or produced identification. This form ensures compliance with Florida construction payment requirements and protects the interests of all parties by documenting that subcontractors have received compensation for work performed during each billing period before the General Contractor receives payment from the project owner.

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Text version

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 .