Form 700-010-38 Certification Disbursement of Previous Periodic Payment to Subcontractors - Florida

Form 700-010-38 or the "Certification Disbursement Of Previous Periodic Payment To Subcontractors" is a form issued by the Florida Department of Transportation.

Download a PDF version of the Form 700-010-38 down below or find it on the Florida Department of Transportation Forms website.

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700-010-38
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
CONSTRUCTION
CERTIFICATION
1/17
DISBURSEMENT OF PREVIOUS PERIODIC PAYMENT TO SUBCONTRACTORS
(As required by Florida Transportation Code, Section 337.11, Subsection (11), F.S.)
DATE
FIN PROJ. I.D.
CONTRACT NO.
TO RELEASE MONTHLY PAYMENT FOR
, prime contractor
for the above referenced contract, hereby certifies that all subcontractors, except for those noted below, having interest in
this contract have received their pro rata share of all previous periodic payments made to date by the Department for all
work, materials and equipment furnished under the contract. The term "subcontractor", as used herein, shall also include
persons or firms furnishing materials, services or equipment incorporated into the work or stockpiled in the vicinity of the
project for which partial payment has been made by the Department and work done under equipment-rental agreements.
EXCEPTION:
The following subcontractors have not been paid and a copy of the notification sent to each, explaining the good cause
why payment has not been made, is attached to this form:
Subcontractor name
Subcontractor name
Street Address
Street Address
City State Zip
City State Zip
State of Florida
A false statement or omission made in connection with this
certification is sufficient cause for suspension, revocation,
County of
or denial of qualification to bid, and a determination of non-
Sworn to and subscribed before me this
day
responsibility, and may subject the person and/or entity
making the false statement to any and all civil and criminal
of
, by
,
penalties available pursuant to applicable Federal and State
(Print name of person signing Certification)
Law.
Notary Public
, not required when digital
Contractor
Commission Expires
By
Personally Known
OR Produced Identification
Type of Identification Produced
Title
Instructions:
1.
Attach copy of the notification good cause sent to each applicable subcontractor.
2.
List the subcontractors which have not been paid the proportionate share of payments received
by the contractor and the date listed as exception.
3.
A separate certification is required for each contract.
4.
To be signed by an officer or director of the Contractor with the authority to bind the Contractor and notarized.
5.
To avoid delay in payment, certification must be submitted to the Project Engineer no later than the Friday
before the monthly estimate cutoff date (generally the 3rd Sunday of the month).
700-010-38
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
CONSTRUCTION
CERTIFICATION
1/17
DISBURSEMENT OF PREVIOUS PERIODIC PAYMENT TO SUBCONTRACTORS
(As required by Florida Transportation Code, Section 337.11, Subsection (11), F.S.)
DATE
FIN PROJ. I.D.
CONTRACT NO.
TO RELEASE MONTHLY PAYMENT FOR
, prime contractor
for the above referenced contract, hereby certifies that all subcontractors, except for those noted below, having interest in
this contract have received their pro rata share of all previous periodic payments made to date by the Department for all
work, materials and equipment furnished under the contract. The term "subcontractor", as used herein, shall also include
persons or firms furnishing materials, services or equipment incorporated into the work or stockpiled in the vicinity of the
project for which partial payment has been made by the Department and work done under equipment-rental agreements.
EXCEPTION:
The following subcontractors have not been paid and a copy of the notification sent to each, explaining the good cause
why payment has not been made, is attached to this form:
Subcontractor name
Subcontractor name
Street Address
Street Address
City State Zip
City State Zip
State of Florida
A false statement or omission made in connection with this
certification is sufficient cause for suspension, revocation,
County of
or denial of qualification to bid, and a determination of non-
Sworn to and subscribed before me this
day
responsibility, and may subject the person and/or entity
making the false statement to any and all civil and criminal
of
, by
,
penalties available pursuant to applicable Federal and State
(Print name of person signing Certification)
Law.
Notary Public
, not required when digital
Contractor
Commission Expires
By
Personally Known
OR Produced Identification
Type of Identification Produced
Title
Instructions:
1.
Attach copy of the notification good cause sent to each applicable subcontractor.
2.
List the subcontractors which have not been paid the proportionate share of payments received
by the contractor and the date listed as exception.
3.
A separate certification is required for each contract.
4.
To be signed by an officer or director of the Contractor with the authority to bind the Contractor and notarized.
5.
To avoid delay in payment, certification must be submitted to the Project Engineer no later than the Friday
before the monthly estimate cutoff date (generally the 3rd Sunday of the month).

Download Form 700-010-38 Certification Disbursement of Previous Periodic Payment to Subcontractors - Florida

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