8-Subcontractors Statement of Satisfaction.pdf.pdf

PDF 118 KB Posted

Attached to
Pipeline Work Order Construction Services - WORCs 6
Solicitation number
IFB-26-00426
Issued by
Hillsborough County, Florida

About this file

This is a Subcontractor's Statement of Satisfaction form issued by Hillsborough County, Florida, for use with construction contracts managed by the County's Capital Projects Department. The form serves as an attestation document that must be completed and notarized by subcontractors to confirm receipt of all monies due from the General Contractor's Application for Payment. Beginning with the second Application for Payment, the General Contractor is required to attach a completed statement for each subcontractor whose work appeared on the prior payment application. The form requires the subcontractor to provide their name, address, title, the project number and name, the General Contractor's identity, the applicable payment application number, and the work period covered. The statement must be sworn before a Florida notary public and include the notary's signature, commission information, and verification of the subcontractor's identity through personal knowledge or identification.

This document is directly associated with the Pipeline Work Order Construction Services solicitation (WORCs 6) valued at approximately $12,075,000.00, which requires qualified contractors to provide construction and installation of water mains, reclaimed water mains, and wastewater force mains at various Hillsborough County Water Resources Department facilities. The solicitation includes a 6% Small Business Enterprise (SBE) subcontractor participation goal. The form updated April 9, 2020, reflects the County's compliance documentation requirements for progress payments and ensures that subcontractors have been compensated before general contractors receive payment authorization.

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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 .