EFT_FORM.pdf

PDF 418 KB Posted

Attached to
Disaster Debris Removal Services State and local contract opportunity
Solicitation number
25/26-018
Issued by
Clay County, Harold 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 Disaster Debris Removal Services contract opportunity. The form enables Clay County to process electronic payments to qualified contractors selected to provide comprehensive debris removal, reduction, and disposal services following disaster-related events. Contractors authorized under this contract will collect and remove eligible debris from County rights-of-way and public properties, with private property debris removal performed only when specifically authorized by the County's Contracting Officer Representative. Historical debris volumes from recent hurricanes have exceeded preliminary estimates of 100,000 cubic yards from Hurricane Milton and several hundred thousand cubic yards from Hurricane Helene, though actual quantities under the contract remain unknown and may fluctuate substantially. All work must be performed systematically and efficiently in compliance with OSHA Safety Standards and applicable federal, state, and local regulations without interfering with ongoing disaster recovery operations.

The EFT Authorization Form requires contractors to provide complete banking information, including financial institution details, account type, routing number, and account number, to facilitate electronic fund transfers from Clay County. Contractors must maintain current account information and notify the County's Comptroller Department immediately of any account closures or changes. The authorization remains in effect until the contractor submits written cancellation to the Comptroller Department. Contractors are directed to submit all inquiries regarding the Request for Bids through the designated question and answer portal and are strictly prohibited from contacting County Board members, employees, management, legal counsel, Evaluation Committee members, or County agents regarding the solicitation during the Request for Bid Period.

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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 .