EFT_FORM.pdf
PDF 418 KB Posted
- Solicitation number
- 25/26-016
- 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 use by vendors, businesses, and individuals receiving payments from Clay County. The form authorizes Clay County's Comptroller and the vendor's designated financial institution to initiate electronic credits and, if necessary, debit entries and adjustments for erroneous transactions. The authorization remains in effect until the vendor submits written cancellation to the Comptroller Department. Vendors must provide complete account information including the financial institution name, account type (checking, savings, or other), transit/ABA/routing number, and account number. The form requires an authorized signature and date, with instructions noting that individuals should contact their financial institution for EFT information if uncertain, while businesses and vendors should verify their complete ACH/EFT details with their financial institution. Vendors are instructed to notify the Comptroller Department immediately upon closing or changing bank accounts.
This form is associated with the Clay County Board of County Commissioners' Request for Qualifications (RFQ) for Construction Engineering and Inspection (CEI) services for the SUN Trail project, a FDOT-funded initiative with a total estimated project cost of $17,051,455 supported entirely by Florida state funding through FDOT's Non-federal STFF category (CSFA 55.038). The RFQ deadline for submitting inquiries is March 30, 2026, at 4:30 pm, with electronic bids due by April 13, 2026, at 4:00 pm through the County's e-Procurement Portal. The selected consultant may request monthly payments based on work completed in accordance with the Florida Local Government Prompt Payment Act, with final invoices due within 120 days of project completion. The EFT form facilitates the County's electronic payment process for the selected consultant, ensuring streamlined fund distribution throughout the contract term, which extends through project completion and demobilization with construction completion targeted for June 30, 2026.
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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 .