Form 700-011-12 "Contractor Certification of Installation" - Florida

What Is Form 700-011-12?

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 April 1, 2018;
  • 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 700-011-12 by clicking the link below or browse more documents and templates provided by the Florida Department of Transportation.

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Download Form 700-011-12 "Contractor Certification of Installation" - Florida

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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
700-011-12
CONSTRUCTION
CONTRACTOR CERTIFICATION
04/18
OF INSTALLATION
Instructions: To be completed by the Responsible Party and submitted to the Project Engineer.
Federal Project Number:
Financial Project Number:
Contract Number:
Project Location:
1.
Certification of Plant Material
I certify that all
small or
large (select one) plant material has been installed and is being established throughout
the project limits, per the Contract Documents.
Comments:
A false statement or omission made in connection with this certification is sufficient cause for suspension, revocation, or denial of qualification to bid, and
a determination of non-responsibility, and may subject the person and/or entity making the false statement to any and all civil and criminal penalties
available pursuant to applicable federal and state law.
State of Florida
County of
Signature of Responsible Party
Sworn to and subscribed before me this
day
of
,
by
(Print name of person signing certification)
By (Print Name)
Notary Public (Not Required if Digitally Signed)
Title
Commission Expires
Personally Known
or Produced Identification
Type of Identification Produced
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
700-011-12
CONSTRUCTION
CONTRACTOR CERTIFICATION
04/18
OF INSTALLATION
Instructions: To be completed by the Responsible Party and submitted to the Project Engineer.
Federal Project Number:
Financial Project Number:
Contract Number:
Project Location:
1.
Certification of Plant Material
I certify that all
small or
large (select one) plant material has been installed and is being established throughout
the project limits, per the Contract Documents.
Comments:
A false statement or omission made in connection with this certification is sufficient cause for suspension, revocation, or denial of qualification to bid, and
a determination of non-responsibility, and may subject the person and/or entity making the false statement to any and all civil and criminal penalties
available pursuant to applicable federal and state law.
State of Florida
County of
Signature of Responsible Party
Sworn to and subscribed before me this
day
of
,
by
(Print name of person signing certification)
By (Print Name)
Notary Public (Not Required if Digitally Signed)
Title
Commission Expires
Personally Known
or Produced Identification
Type of Identification Produced