Project_Contract_Forms.pdf

PF – 1 ( 1 of 1)

PROJECT FORMS

ARTICLE 1 - INSTRUCTIONS

1.1. The following forms and certificates are samples of those to be used by the Contractor for submissions for Contractual and administrative requirements.

1.2. Requirements and instructions on the forms constitute extensions of, or additions to, the Contractual conditions of the Contract and the general requirements of the specification.

1.3. Do not detach, or otherwise remove sample project forms from specifications.

1.4. Prepare all forms as required with all blank spaces filled in, in ink or typewritten.

1.5 Submit all Forms to the Office of the County Engineer

ARTICLE 2 - PROJECT FORM LISTING

Part 1: Standard Contract Administration Forms

Application and Certificate for Payment (PF – 2) (Prepared and submitted by prime contractor monthly for progress payment)

Continuation Sheet (PF – 3) (Prepared and submitted by prime contractor as itemized breakdown of monthly progress payment)

Agreement Amendment (PF – 4) (Prepared by Engineer for contract revision)

Contractor's Affidavit for Payment of Debts and Claims (PF – 5) (Prepared and submitted by prime contractor as part of project close-out documentation to be accompanied by separate release or waivers of lien from sub-contractors and material and equipment suppliers)

Contractor's Affidavit of Release of Liens (Final Release) (PF – 6) (Prepared and submitted by prime contractor as part of project close-out documentation)

Consent of Surety Company To Final Payment (PF – 7) (Prepared and submitted by prime contractor as part of project close-out documentation)

Partial Release of Lien (PF – 8) (Submitted monthly by prime contractor with each invoice beginning with the second progress payment application)

Conditional Final Release and Waiver of Lien (PF – 9) (Prepared and submitted by prime contractor as part of project close-out documentation)

Final Release of Lien (PF -10) (Prepared and submitted by prime contractor as part of project close-out documentation)

Certificate of Substantial Completion (PF – 11) (Prepared by Engineer)

Certificate of Final Completion (PF – 12) (Prepared by Engineer)

PAYMENT APPLICATION FORM

FLAGLER COUNTY APPLICATION FOR PAYMENT NO. ____________________

CONTRACTOR: _____________________________ ENGINEER: Flagler County Engineering Dept.

(Address:)

Bunnell, Florida 32110

ORIGINAL CONTRACT SUM $

NET REVISIONS $

CONTRACT SUM TO DATE $

TOTAL COMPLETE TO DATE $

Less: Retainage @ ____% $

EARNED LESS RETAINAGE $

PAYMENT FOR STORED MATERIALS $

TOTAL LESS RETAINAGE $

TOTAL REVISIONS LESS PREVIOUS PAYMENTS MADE $

NET REVISIONS: $______________________ AMOUNT DUE THIS APPLICATION $_______________________

CONTRACTOR:______________________________

BY:

SIGNED:

NOTARY PUBLIC:

DATE: ______________ MY COMMISSION EXPIRES: _______________

RECOMMENDED FOR ACCEPTANCE AND PAYMENT:

DATE: _______________ COUNTY ENGINEER:

CHANGE ORDER

No._____ Approval

DATE

Payment in the amount shown is due for work performed during the period of _________ thru ________, as detail on the attached Schedule of Payments. The present status of the Account for this Contract is :

Project Name & No.: __________________________________________________________________________________

The undersigned certifies that the Work covered by this Application for Payment has been completed in accordance with the Contract Documents and/or any Amendments thereto, that all amounts due Subcontractors and Suppliers for Work, for which previous Applications for Payment were issued and payment has been received from Flagler County, has been paid by him; that all Subcontractors and Suppliers have issued Releases of Lien and the current payment shown herein is now due.

1769 E. Moody Blvd. Bldg. 2

Subscribed & Sworn to before me this ____day of

PF - 2

ADDITION DEDUCTION

AMENDMENTS TO CONTRACT PAYMENT DUE THIS APPLICATION

APPLICATION FOR PAYMENT CONTINUATION FORM

FLAGLER COUNTY - CONTRACTOR'S APPLICATION FOR PAYMENT - SHEET ______ OF ______

PROJECT NAME: PROJ. NO.: SCHEDULE:

CONTRACTOR: COVERING PERIOD: THRU

APPLICATION No. DATE: BY: REVIEWED BY:

NO. PREVIOUS TOTAL THIS PERIOD TOTAL TO DATE PREVIOUS TOTAL THIS PERIOD TOTAL TO DATE

PF - 3

ITEM

DESCRIPTION

CONTRACT

QUANTITY UNIT UNIT

PRICE

QUANTITY INSTALLED & COMPLETE DOLLAR AMOUNT

PF-4

AMENDMENT TO AN AGREEMENT

BETWEEN FLAGLER COUNTY

AND

Contractor Name____________________________________________ Project Name_______________________________________________

County Project No. ________________________

Flagler County, Florida, a political subdivision (COUNTY) and (CONTRACTOR) hereby enter into this Amendment to the Agreement executed on .

WHEREAS, COUNTY AND CONTRACTOR have entered into an Agreement for on , .

WHEREAS, the PARTIES have entered into a Amendment on , for the purpose of:

1. The ending date for the AGREEMENT subsequent to this Amendment.

2. All Terms and Conditions of the original Contract and any subsequent amendments thereto shall remain unmodified and shall remain in full force and effect.

3. This Amendment must be accepted by the CONTRACTOR and Contract Surety and must be approved by the Flagler County Board of County Commissioners to become effective.

AMOUNT TIME

Original Contract Agreement........................ $ _____________

CHANGES BY PREVIOUS AMENDMENTS:

NO. DATE APPROVED

TOTAL CHANGES BY AMENDMENT NO. thru $

TOTAL CONTRACT prior to this Amendment (No. )........................$

TOTAL This Amendment..........................................................................$

NEW CONTRACT (All Amendments)...................................................... $

PF-4

ACCEPTANCE: (CONTRACTOR)

I (We) agree to perform the work required by this Amendment No.

________ for the amount and within the time allocated all in accordance with Contract Plans, Specifications and related Documents.

NAME:

WITNESS:

(Signature)

BY: DATE:

(Typed or Printed) (Signature)

WITNESS:

(Signature) (Typed/Printed Name & Title)

(Typed or Printed)

SURETY

I (We) have reviewed the foregoing Contract and Amendment and have adjusted the Contract Sureties to Conform with this Amendment.

SURETY:

BY: DATE:

(Typed/Printed Name & Title) (Agent-In-Fact Certification Attached)

RECOMMENDED: RECOMMENDED:

Flagler County Engineering Dept.

(Date) (Date)

(Typed/Printed Name & Title)

APPROVED AS TO FORM: APPROVED: FLAGLER COUNTY

Flagler County Legal Dept.

____________________________________ BY:

(Date) (Date)

PF - 5

CONTRACTOR’S OWNER

AFFIDAVIT OF ENGINEER

PAYMENT OF CONTRACTOR

DEBTS AND CLAIMS SURETY

OTHER

TO: (OWNER) : FLAGLER COUNTY PROJECT NO.: ______________________________

BOARD OF COUNTY COMMISSIONERS

CONTRACT FOR: _______________________________________________________________________________________________________________

CONTRACTOR (NAME, ADDRESS) CONTRACT DATE:_______________________________________

STATE OF: _________________________

COUNTY OF: _______________________

The undersigned, pursuant to the Standard Conditions of the Contract for Construction, hereby certifies that, except as listed below, he has paid in full or has otherwise satisfied all obligations for all materials and equipment furnished, for all work, labor, and services performed, and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or his property might in any way be held responsible.

EXCEPTIONS: (If none, write “NONE”. If required by the Owner, the Contractor shall furnish bond satisfactory to the Owner for each exception).

SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR:____________________________

1. Consent of Surety to Final Payment, Whenever Surety is involved

Consent of Surety is required. ADDRESS:_________________________________

Indicate attachments (YES___) (NO ____)

The following supporting documents should be attached hereto if required by the OWNER. BY: ______________________________________

1. Contractor’s Release or Waiver of Liens, conditional upon receipt of Final Payment. Subscribed and Sworn to before me this _____ Day of _________, 20__

2. Separate Release or Waivers of Leans from Sub-contractors and material and equipment suppliers to the extent required by the Owner, accomplished by a list thereof. NOTARY PUBLIC: ______________________

3. Contractor’s Affidavit of Release of Liens My Commission Expires:________________

PF - 6

CONTRACTOR’S OWNER

AFFIDAVIT OF ENGINEER

RELEASE OF LIENS CONTRACTOR

OTHER

TO: (OWNER) FLAGLER COUNTY PROJECT NO.: ______________________________

CONTRACT FOR: ________________________________________________________________________________________________

CONTRACTOR (NAME, ADDRESS) CONTRACT DATE:_______________________________________

The undersigned, pursuant to the Standard General Conditions of the Contract for Construction, hereby certifies that all Contractors, all Sub-contractors, all suppliers of material and equipment and all performers of work, labor or services who have or may have liens against any property of the Owner arising in any manner out of the performance of the Contact referenced above have been paid in full.

EXCEPTION: (If none, write “NONE”. If required by the Owner, the Contractor shall furnish bond satisfactory to the Owner for each exception).

SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: ___________________________

1. Contractor’s Release or Waiver of Liens, conditional upon receipt ADDRESS:_________________________________ of Final Payment. _________________________________

2. Separate Release or Waivers of Liens from Sub-contractors and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. BY: _______________________________________

Subscribed and Sworn to before me this ______Day of _____________, 20___

NOTARY PUBLIC:______________________________

My Commission Expires:___________________________

PF - 7

CONSENT OF OWNER

SURETY COMPANY ENGINEER

TO FINAL PAYMENT CONTRACTOR

OTHER

TO: (OWNER) PROJECT NO.: _____________________________________

FLAGLER COUNTY

CONTRACT FOR: __________________________________________________________________________________________

CONTRACTOR: (NAME, ADDRESS)

CONTRACT DATE:_______________________________________

Pursuant to § 255.05(11), Florida Statutes, and in accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (Insert Name and Address of Surety Company)

SURETY COMPANY:

on Bond of (Insert Name and Address of Contractor)

CONTRACTOR:

hereby approves of the Final Payment to the Contractor, and agrees that Final Payment to the Contractor shall not relieve the Surety Company of any of its obligations to (Insert Name and Address of Owner).

OWNER:

Flagler County Board of County Commissioners, with an address of 1769 E. Moody Boulevard, Building 2, Bunnell, Florida 32110 as set for in the said Surety Company’s Bond.

IN WITNESS WHEREOF, the Surety Company has hereunto set its hand the _______Day of _______________________, _______.

SURETY COMPANY

ATTEST: ________________________________________________

(SEAL) SIGNATURE OF AUTHORIZED REPRESENTATIVE

TITLE

PF – 8

WAIVER AND RELEASE OF LIEN

UPON PROGRESS PAYMENT

“PARTIAL RELEASE OF LIEN”

The undersigned Lienor, in consideration of $____________________________________, ____________________________________hereby waives and releases its lien and right to

(COMPANY/CONTRACTOR)

claim a lien for labor, services, or materials furnished through ____________ to _____________

(DATE) (DATE)

to the Flagler County Board of County Commissioners on the job of

PROJECT NO. ________________________________

PROJECT NAME: ___________________________________________________________

to the following described property: _______________________________________________

(DESCRIPTION OF PROPERTY)

This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.

This Partial Release is furnished in accordance with 713.2(3), Florida Statutes.

DATED on _______________________, 20 ____

By:___________________________________ (Signature of Lienor)

(Printed Name & Title)

Lienor’s Name and Address: __________________________________________________

STATE OF FLORIDA

COUNTY OF ____________

Sworn to (or affirmed) and subscribed before me this ________ day of _____________, 20___ by ____________________________________.

SIGNATURE OF NOTARY PUBLIC

Print, Type or Stamp Commissioned Name

Personally Known ______________ OR Produced Identification _____________

Type of Identification Produced ___________________________________

PF – 9

CONDITIONAL FINAL RELEASE AND WAIVER OF LIEN

The undersigned Lienor, in consideration of $____________________________________, ____________________________________hereby waives and releases its lien and right to

(COMPANY/CONTRACTOR)

claim a lien for labor, services, or materials furnished through ____________ to _____________

(DATE) (DATE)

to the Flagler County Board of County Commissioners on the job of

PROJECT NO. _____________________________

PROJECT NAME: ___________________________________________________________

to the following described property: _______________________________________________

(Description of Property)

This undersigned certifies that all labor, services, and/or materials described herein have been provided to the execution and delivery of this document.

The Conditional Final Release and Lien Waiver is conditioned upon the undersigned receiving $____________________ for the work described in this Release and Waiver.

The Conditional Final Release is furnished in accordance with 713.20, Florida Statutes.

DATED on ________, _______________, 20 ____

By:____________________________________________

(Printed Name & Title) Lienor’s Name and Address: ______________________________________________________

STATE OF FLORIDA

COUNTY OF ____________

Print, Type or Stamp Commissioned Name

Personally Known ______________ OR Produced Identification ___________________

PF – 10

WAIVER AND RELEASE OF LIEN

UPON FINAL PAYMENT

The undersigned lienor, in consideration of the final payment in the amount of $________________________, hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished to the Flagler County Board of County Commissioners on the job of

PROJECT NO.:_____________________

PROJECT NAME: ____________________________________________________________

to the following described property: _______________________________________________

(Description of Property)

This Final Release is furnished in accordance with 713.2(5), Florida Statutes.

DATED on ________, _______________, 20 ____

By:___________________________________

(Printed Name & Title)

Lienor’s Name and Address: _____________________________________________

STATE OF FLORIDA

COUNTY OF ____________

Print, Type or Stamp Commissioned Name

Personally Known ______________ OR Produced Identification ______________

PF – 11 (1 of 2)

CERTIFICATE OF SUBSTANTIAL COMPLETION

PROJECT: ___________________________________________________________________

CONTRACT DATE:______________________________________

COUNTY PROJECT NO.: ________________________

This Certificate of Substantial Completion applies to:

_____ All work under Contract _____ Portion of work described as follows:

The Work to which this Certificate applies has been inspected by authorized representatives identified below and that Work is hereby declared to be substantially complete in accordance with the Contract Documents on:______________________

(DATE)

A tentative list of items to be completed or corrected is attached hereto. This list may not be all-inclusive, and the failure to include an item in it does not alter the responsibility of Contractor to complete all the Work in accordance with the Contract Documents. The items in the tentative list shall be completed or corrected by the Contractor.

SIGNED:

CONTRACTOR: ____________________________________________________________

By: __________________________________________ Date:______________________________________

FLAGLER COUNTY CONSTRUCTION ENGINEERING & INSPECTION (CEI)

(CEI FIRM)_________________________________________________________________

FLAGLER COUNTY PROJECT MANAGER

OTHER____________________________________________________________________

PF – 11 (2 of 2)

TENTATIVE LIST OF ITEMS TO BE COMPLETED OR CORRECTED

(PUNCH LIST)

PROJECT: ________________________________________ DATE:___________________

COUNTY PROJECT NO.: ___________________________________

CONTRACTOR: ______________________________________________________

This list may not be all-inclusive, and the failure to include an item does not alter the responsibility of the Contractor to complete all the Work in accordance with the Contract Documents.

ITEM NO. DESCRIPTION

PF - 12

CERTIFICATE OF FINAL COMPLETION

PROJECT: _______________________________________________________________

CONTRACT DATE:_____________

COUNTY PROJECT NO.: ____________________________

This Certificate of Final Completion applies to:

_____ All work under Contract _____ Portion of work described as follows:

The Work to which this Certificate applies has been inspected by authorized representatives identified below and that Work is hereby declared to be complete in accordance with the Contract Documents on:________________________________

(DATE)

The tentative list (punch list) of items to be completed or corrected provided with the Certificate of Substantial Completion has been addressed. Failure to have included an item in the does not alter the responsibility of Contractor to complete all the Work in accordance with the Contract Documents.

The date of Final Completion is the date upon which all guarantees and warranties begin.

FINAL COMPLETION DATE:________________________________________

SIGNED:

CONTRACTOR: ____________________________________________________________

FLAGLER COUNTY CONSTRUCTION ENGINEERING & INSPECTION

REPRESENTATIVE: _______________________________________________

FLAGLER COUNTY PROJECT MANAGER