Fax Order Form.pdf

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

ORDER FORM

District One Contracts Administration Phone: (863) 519-2567

Email Address: D1-Contracts@dot.state.fl.us

Exempt Documents - Section 119.071(3) (b) Florida Statutes, provides:

Building plans, blueprints, schematic drawings, and diagrams, including draft, preliminary, and final formats, which depict the internal layout and structural elements of a building, arena, stadium, water treatment facility, or other structure owned or operated by an agency are exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution. This exemption applies to building plans, blueprints, schematic drawings, and diagrams, including draft, preliminary, and final formats, which depict the internal layout and structural elements of a building, arena, stadium, water treatment facility, or other structure owned or operated by an agency before, on, or after the effective date of this act. Information made exempt by this paragraph may be disclosed to another governmental entity if disclosure is necessary for the receiving entity to perform its duties and responsibilities; to a licensed architect, engineer, or contractor who is performing work on or related to the building, arena, stadium, water treatment facility, or other structure owned or operated by an agency; or upon a showing of good cause before a court of competent jurisdiction. The entities or persons receiving such information shall maintain the exempt status of the information.

Check one: Licensed ____Architect ____Engineer ____Contractor

Other: (please state nature of business) ________________________________________________________________ Company/Entity Name: _____________________________________________________________________________ Address: _________________________________________________________________________________________ Phone Number: ____________________________________________________________________________________ Fax Number: ______________________________________________________________________________________ Email Address: ____________________________________________________________________________________

Letting Date Proposal ID Project Number Bidding Documents including Plans & Specs (Prime Contractor Only)

Plans & Specs Only (Subcontractors/Suppliers)

5/26/2022 F1A01 448210-1-52-01

Signature required for receipt of the above records.

I, personally, and/or as representative of the above entity, fully understand the exempt nature of the public records I am receiving and agree to maintain the exempt status of this information in accordance with Florida law.

Name of person receiving records:

(Printed) _________________________________________________________________________________________

Signature: _____________________________________________________________ Date: ______________________