Contractors Affidavit for Payment of Debts and Claims 02.18.2026.pdf

PDF 543 KB Posted

Attached to
Northwest Transfer Station Community Collection Center (NWTS CCC) Floor Upgrades
Solicitation number
IFB-26-00265
Issued by
Hillsborough County, Florida

About this file

This is a Contractor's Affidavit of Payment of Debts and Claims form required by the Hillsborough County Board of County Commissioners in Florida for the Northwest Transfer Station Community Collection Center (NWTS CCC) Floor Upgrades project. The affidavit certifies that the contractor has paid all bills for labor, services, and materials furnished by the contractor and all suppliers and subcontractors under the project agreement, including all known indebtedness and claims for damages arising from performance of the contract. The form requires the contractor to document exceptions to full payment, if any exist, and must be notarized before a Florida notary public by means of physical presence or online notarization. The document serves as a completion requirement and financial accountability measure for the project.

The affidavit is a standard contractual instrument with no specific pricing, payment terms, or set-asides detailed within the form itself. However, the related contract opportunity indicates an estimated project cost of $2,243,136.50 for cast-in-place concrete work, demolition, and installation services at the Northwest Transfer Station Community Collection Center. The solicitation establishes a 5 percent Small Business Enterprise (SBE) participation goal for subcontractors on the project. Completion of this affidavit is a prerequisite for final payment and contract closure, ensuring the contractor's financial obligations have been satisfied before project completion.

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Text version

CONTRACTOR’S AFFIDAVIT OF

PAYMENT OF DEBTS AND CLAIMS

The undersigned hereby certifies that except as noted below all bills for labor, services and materials furnished by the CONTRACTOR and all suppliers and/or subcontractors of the CONTRACTOR under and pursuant to the provisions of the Agreement dated the ________ day of _______________, 20_____, between the Hillsborough County Board of County Commissioners (COUNTY) and _________________________________________ (CONTRACTOR) concerning that certain project designated as __________________________________________________________ have been paid in full or otherwise satisfied including all known indebtedness and all claims for damages against said CONTRACTOR arising in any manner in connection with the performance of the Agreement referenced above for which the COUNTY might in any way be held responsible.

Exceptions: ________ (If none, write “None”.)

__________ (If yes, write “Yes” and attach list.)

Certified this ________ day of _________________, 20 ______.

CONTRACTOR:

BY:

Title

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 .