6-Subcontractors Statement of Satisfaction.pdf.pdf

PDF 118 KB Posted

Attached to
Valrico Reclaimed Water Facility Diesel Generator Project
Solicitation number
IFB-26-00406
Issued by
Hillsborough County, Wright CDP, Florida

About this file

This is a Subcontractor's Statement of Satisfaction form utilized by Hillsborough County, Florida for the Valrico Reclaimed Water Facility Diesel Generator Project. The form serves as an attestation that must be attached to each Application for Payment submitted by the General Contractor, beginning with the second application. The statement applies to all subcontractors whose work appeared on the prior Application for Payment for which the General Contractor received payment. The form requires a subcontractor or representative to swear under oath that all monies due from the General Contractor's most recent Application for Payment have been paid in full, covering the specified period of work. The statement must be notarized before a Florida Notary Public and include verification of the notary's authority through physical presence or online notarization.

The project involves the addition of a new 1,500 kilowatt/1,875 kilovolt-ampere diesel-driven generator housed in a walk-in enclosure and mounted on an 8,500-gallon sub-base diesel fuel tank at the existing Valrico Reclaimed Water Facility, with an estimated project value of $4,728,600. The project is partially funded through the Hazard Mitigation Grant Program and Hazard Mitigation Grant Match Program. A Small Business Enterprise (SBE) subcontractor participation goal of 5 percent has been established in connection with the solicitation and resulting contract.

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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 .