EFT_FORM.pdf

PDF 418 KB Posted

Attached to
Omega Park CCUA Connection
Solicitation number
25/26-007
Issued by
Clay County, Miramar Beach CDP, Florida

About this file

This is an Electronic Funds Transfer (EFT) Authorization Form issued by the Clay County Clerk of Court and Comptroller in Florida for the Omega Park CCUA Connection project (Invitation for Bid #25/26-007). The form authorizes Clay County Comptroller's office and the vendor's designated financial institution to initiate electronic credits and, if necessary, debit entries for payments related to contract work. The project involves utility improvements at Omega Community Park located at 4317 County Road 218 in Middleburg, Florida, requiring contractors to furnish and install approximately 190 linear feet of 8-inch PVC gravity sewer main, 335 linear feet of 2-inch water service, and 484 linear feet of 2-inch force main. A mandatory pre-bid meeting is scheduled for October 30, 2025, at 1:00 PM on-site, with bids due November 20, 2025, at 4:00 PM. The project has a substantial completion timeline of 120 calendar days from the Notice to Proceed, with final completion within 150 calendar days. Qualified contractors must have a minimum of five years of experience performing similar work.

The EFT form requires vendors to provide complete banking information including financial institution name, account type, routing number, and account number. A 5% bid bond is required for bid submission. Award will be made to the lowest responsive and responsible bidder. The total connection charges for the project amount to $27,670.30, which includes potable water capacity charges, alternative water supply surcharges, wastewater capacity charges, and environmental impact fees. Bidders must comply with comprehensive insurance requirements including commercial general liability, business automobile liability, workers' compensation, and property coverage. The authorization remains in effect until cancelled in writing by the vendor, and vendors must notify the Comptroller Department immediately if they close or change their bank account. Chen Moore and Associates serves as the engineering design firm for the project.

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Text version

Clay County Clerk of Court and Comptroller

EFT Authorization Form

Individual/Business/Vendor Name: (Please Print)

Phone Number:

Email:

I/We hereby authorize Clay County Comptrollers and the financial institution listed below to initiate electronic credits, and, if necessary, debit entries and adjustments for any credit entries in error. This authority will remain in effect until I cancel it in writing to the Comptroller Department. *Notify the Comptroller Department immediately if you close or change Bank Account*

Account Information:

Financial Institution:

Type of Account (please circle one): Checking Savings Other:______________

Transit / ABA / Routing #:

Account Number:

*Individuals: If you are unsure of your complete EFT information please contact your financial institution. In most cases, your financial institution can provide you with a direct deposit/EFT letter or a voided check.

Businesses/Vendors: Please check with your financial institution for your complete ACH/EFT information.

Authorized Signature:_______________________________ Date: ___________

File details come from the government source that posted it. Updated .