Form 700-011-04 Certification Work Done by Contractor or Subcontractor Under the Florida Minority Business Loan Mobilization Program - Florida

Form 700-011-04 is a Florida Department of Transportation form also known as the "Certification Work Done By Contractor Or Subcontractor Under The Florida Minority Business Loan Mobilization Program". The latest edition of the form was released in February 1, 2018 and is available for digital filing.

Download a PDF version of the Form 700-011-04 down below or find it on Florida Department of Transportation Forms website.

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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
700-011-04
CONSTRUCTION
CERTIFICATION
02/18
WORK DONE BY CONTRACTOR OR SUBCONTRACTOR UNDER
THE FLORIDA MINORITY BUSINESS LOAN MOBILIZATION PROGRAM
DATE:
FIN PROJ. I.D.:
CONTRACT NO.:
FOR MONTH OF:
, PARTICIPANT IN THE FLORIDA
MINORITY BUSINESS LOAN MOBILIZATION PROGRAM, HEREBY CERTIFIES THAT THE FOLLOWING
REPRESENTS THE TRUE VALUE OF WORK DONE FOR THE CURRENT PAYMENT PERIOD.
PAY ITEM
QUANTITY
UNIT OF MEASURE
UNIT PRICE
AMOUNT
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
emarks:
R
THIS AMOUNT WILL BE DEDUCTED FROM THE MONIES
ADVANCED TO YOU UNDER THIS PROGRAM IN ACCORDANCE
WITH SEC. 7-1.9 OF THE SPECIFICATIONS.
$ 0.00
TOTAL
PROGRAM PARTICIPANT
PRIME CONTRACTOR (IF SUBCONTRACTOR IS PARTICIPANT)
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
700-011-04
CONSTRUCTION
CERTIFICATION
02/18
WORK DONE BY CONTRACTOR OR SUBCONTRACTOR UNDER
THE FLORIDA MINORITY BUSINESS LOAN MOBILIZATION PROGRAM
DATE:
FIN PROJ. I.D.:
CONTRACT NO.:
FOR MONTH OF:
, PARTICIPANT IN THE FLORIDA
MINORITY BUSINESS LOAN MOBILIZATION PROGRAM, HEREBY CERTIFIES THAT THE FOLLOWING
REPRESENTS THE TRUE VALUE OF WORK DONE FOR THE CURRENT PAYMENT PERIOD.
PAY ITEM
QUANTITY
UNIT OF MEASURE
UNIT PRICE
AMOUNT
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
emarks:
R
THIS AMOUNT WILL BE DEDUCTED FROM THE MONIES
ADVANCED TO YOU UNDER THIS PROGRAM IN ACCORDANCE
WITH SEC. 7-1.9 OF THE SPECIFICATIONS.
$ 0.00
TOTAL
PROGRAM PARTICIPANT
PRIME CONTRACTOR (IF SUBCONTRACTOR IS PARTICIPANT)

Download Form 700-011-04 Certification Work Done by Contractor or Subcontractor Under the Florida Minority Business Loan Mobilization Program - Florida

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