Form 700-010-42 Certification and Request for Payment for Stockpiled Materials - Florida

Form 700-010-42 is a Florida Department of Transportation form also known as the "Certification And Request For Payment For Stockpiled Materials". The latest edition of the form was released in February 1, 2017 and is available for digital filing.

Download an up-to-date Form 700-010-42 in PDF-format down below or look it up on the Florida Department of Transportation Forms website.

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700-010-42
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
CERTIFICATION AND REQUEST FOR PAYMENT FOR
CONSTRUCTION
02/17
STOCKPILED MATERIALS
Date:
Financial Proj. ID:
State Project No.:
F.A. Job No.:
Prime Contractor:
STOCKPILED MATERIALS FOR WHICH PAYMENT IS REQUESTED**
COST*
PAY ITEM INTO
LOCATION
QUANTITY
WHICH TO BE
MATERIAL
WHERE
TRANSPOR-
& UNIT
MATERIAL
TOTAL
INCORPORATED
STORED
TATION
Verification:
FOR DEPARTMENT USE ONLY
Location
Specification/Certification Requirement
Signature:
Date:
*Invoices substantiating quantities and costs are attached hereto.
**Request must be made at least 5 working days prior to cutoff.
Payment is requested for materials we have purchased for future incorporation into the above referred project. In requesting this payment we certify
to the following:
1. The quantities of materials for which payment is requested have in fact been delivered to and are stored at the location listed above.
2. The amounts requested are the actual amounts expended for purchase and transportation of the materials.
3. All material for which payment is requested meets the applicable specifications as set out in the contract.
4. All material is stockpiled at the location listed above in a manner such that they are readily discernible as the materials for which payment is
requested.
5. The specific materials shown on the attached listing will be retained at the location designated for exclusive use in construction of this
project.
6. The Project Engineer will be notified prior to beginning incorporation of any listed materials into the project.
Signature
Firm Name (Prime Contractor)
Title
700-010-42
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
CERTIFICATION AND REQUEST FOR PAYMENT FOR
CONSTRUCTION
02/17
STOCKPILED MATERIALS
Date:
Financial Proj. ID:
State Project No.:
F.A. Job No.:
Prime Contractor:
STOCKPILED MATERIALS FOR WHICH PAYMENT IS REQUESTED**
COST*
PAY ITEM INTO
LOCATION
QUANTITY
WHICH TO BE
MATERIAL
WHERE
TRANSPOR-
& UNIT
MATERIAL
TOTAL
INCORPORATED
STORED
TATION
Verification:
FOR DEPARTMENT USE ONLY
Location
Specification/Certification Requirement
Signature:
Date:
*Invoices substantiating quantities and costs are attached hereto.
**Request must be made at least 5 working days prior to cutoff.
Payment is requested for materials we have purchased for future incorporation into the above referred project. In requesting this payment we certify
to the following:
1. The quantities of materials for which payment is requested have in fact been delivered to and are stored at the location listed above.
2. The amounts requested are the actual amounts expended for purchase and transportation of the materials.
3. All material for which payment is requested meets the applicable specifications as set out in the contract.
4. All material is stockpiled at the location listed above in a manner such that they are readily discernible as the materials for which payment is
requested.
5. The specific materials shown on the attached listing will be retained at the location designated for exclusive use in construction of this
project.
6. The Project Engineer will be notified prior to beginning incorporation of any listed materials into the project.
Signature
Firm Name (Prime Contractor)
Title

Download Form 700-010-42 Certification and Request for Payment for Stockpiled Materials - Florida

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