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

What Is Form 700-050-38?

This is a legal form that was released by the Florida Department of Transportation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2016;
  • The latest edition provided by the Florida Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 700-050-38 by clicking the link below or browse more documents and templates provided by the Florida Department of Transportation.

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

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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