Attachment K - CONTRACTOR DECLARATION.pdf
PDF 32 KB Posted
- Attached to
- Insulation at Fire Stations 3 and 4
- Solicitation number
- 24-015
- Issued by
- Macomb County, St. Louis City, Michigan
About this file
This document is a Contractor's Declaration form from Macomb Township for the Insulation at Fire Stations 3 & 4 project, identified with Contract No. 24-015. The form is designed to be attached to the contractor's periodic request for payment and serves as a certification of work performed, materials furnished, and any potential claims during the contract period. The project involves installing expanding foam insulation at two fire stations located in Macomb, Michigan: Fire Station #3 at 47711 North Avenue and Fire Station #4 at 16820 25 Mile Road.
The declaration requires the contractor to certify that they have not performed any work or incurred any losses beyond the regular contract items, except for any previously submitted claim letters detailing additional compensation or time extension requests. For proposals of $50,000 or more, proposers will be required to furnish US Treasury Listed Company Bonds. The form provides space for the contractor to sign, print their name, provide their title, and date the document, ensuring transparency and accountability in the contract performance process.
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Text version
Macomb Township Attachment K
CONTRACTOR'S DECLARATION
(To be attached to the Contractor's periodic Request for Payment)
Project Name: Insulation at Fire Stations 3 & 4
Contract No.: 24-015
Contract Date:
Contractor:
Owner: Macomb Township
Certification Period (From the Date of the Contract to the Date of this Declaration)
I hereby certify that I have not, during the above noted certification period, performed any work, furnished any material, sustained any loss, damage or delay for any reason, or otherwise done anything for which I shall ask, demand, sue for, or claim compensation from the Owner or its agents, in addition to the regular items set forth in the above noted Contract (and executed Change Orders thereto) executed between the Contractor and the Township, except as the Contractor hereby claim for additional compensation and/or extension of time as described in previously submitted claim letters to the Township dated:
Attached Summary, Dated
(Contractor to check this box if no claim letters are submitted to date)
CONTRACTOR
By:
(Authorized Signature)
Name:
(Print Name)
Title:
Date:
File details come from the government source that posted it. Updated .