Form 700-050-38 Certification as to Accuracy of Final Payment - Florida

Form 700-050-38 is a Florida Department of Transportation form also known as the "Certification As To Accuracy Of Final Payment". The latest edition of the form was released in December 1, 2016 and is available for digital filing.

Download a PDF version of the Form 700-050-38 down below or find it on Florida Department of Transportation Forms website.

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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
700-050-38
CERTIFICATION AS TO ACCURACY OF FINAL PAYMENT
OGC - CONSTRUCTION
12/16
The undersigned _________________________________ , on behalf of and as a duly authorized representative
of ________________________________________ , (hereinafter referred to as the “Consultant”) hereby
certifies, to the best of Consultant’s knowledge, information and belief, to the Florida Department of
Transportation (hereinafter referred to as the “Department”) as follows:
1.
That the Final Estimate package for Contract Number _______________ , Financial Project
Number(s) ________________________________________________________________ , (hereinafter
referred to as the “Final Estimate”) is in compliance with the Contract, Statewide Quality Control Plan or
other acceptable plan as developed by the Consultant, and the Department’s procedures; and
2.
That the Final Estimate is true and correct as determined by the Consultant’s reasonable and
independent investigation and measurements; and
3.
That the Consultant hereby recommends that the Department make payment based on the
attached Final Estimate; and
4.
That the Consultant hereby agrees to indemnify and hold the Florida Department of Transportation,
its officers and employees harmless from all liabilities, damages, costs, and attorney fees incurred and paid as a
result of the negligence, recklessness, or intentional wrongful misconduct of the Consultant and persons employed
or utilized by the Consultant in the preparation and/or audit of the Final Estimate as outlined in the Scope of
Services. The Department also reserves the right to recover from the Consultant any increased costs, delays or
other damages to the Department due to errors and/or omissions under applicable Florida Statutes (334.044(2);
334.048.20.23(3)(a) and 337.015).
5.
Monetary Amount Submitted $ __________________________ .
State of Florida
A false statement or omission made in connection with
this certification is sufficient cause for suspension,
County of _______________________
revocation or denial of qualification, and may subject
Sworn to and subscribed before me this ___________ day of
the person and/or entity making false statement to any
______, by ___________________________
_______________,
or all civil and criminal penalties available pursuant to
applicable Federal and State Law.
(Print name of person signing Certification)
Notary Public
(Not Required if Digitally Signed)
Consultant
Commission Expires
T i t l e
Personally Known
OR Produced Identification
Type of Identification Produced _____________________
By
Signed
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
700-050-38
CERTIFICATION AS TO ACCURACY OF FINAL PAYMENT
OGC - CONSTRUCTION
12/16
The undersigned _________________________________ , on behalf of and as a duly authorized representative
of ________________________________________ , (hereinafter referred to as the “Consultant”) hereby
certifies, to the best of Consultant’s knowledge, information and belief, to the Florida Department of
Transportation (hereinafter referred to as the “Department”) as follows:
1.
That the Final Estimate package for Contract Number _______________ , Financial Project
Number(s) ________________________________________________________________ , (hereinafter
referred to as the “Final Estimate”) is in compliance with the Contract, Statewide Quality Control Plan or
other acceptable plan as developed by the Consultant, and the Department’s procedures; and
2.
That the Final Estimate is true and correct as determined by the Consultant’s reasonable and
independent investigation and measurements; and
3.
That the Consultant hereby recommends that the Department make payment based on the
attached Final Estimate; and
4.
That the Consultant hereby agrees to indemnify and hold the Florida Department of Transportation,
its officers and employees harmless from all liabilities, damages, costs, and attorney fees incurred and paid as a
result of the negligence, recklessness, or intentional wrongful misconduct of the Consultant and persons employed
or utilized by the Consultant in the preparation and/or audit of the Final Estimate as outlined in the Scope of
Services. The Department also reserves the right to recover from the Consultant any increased costs, delays or
other damages to the Department due to errors and/or omissions under applicable Florida Statutes (334.044(2);
334.048.20.23(3)(a) and 337.015).
5.
Monetary Amount Submitted $ __________________________ .
State of Florida
A false statement or omission made in connection with
this certification is sufficient cause for suspension,
County of _______________________
revocation or denial of qualification, and may subject
Sworn to and subscribed before me this ___________ day of
the person and/or entity making false statement to any
______, by ___________________________
_______________,
or all civil and criminal penalties available pursuant to
applicable Federal and State Law.
(Print name of person signing Certification)
Notary Public
(Not Required if Digitally Signed)
Consultant
Commission Expires
T i t l e
Personally Known
OR Produced Identification
Type of Identification Produced _____________________
By
Signed

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