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

Form 700-011-12 is a Florida Department of Transportation form also known as the "Contractor Certification Of Installation". The latest edition of the form was released in April 1, 2018 and is available for digital filing.

Download an up-to-date Form 700-011-12 in PDF-format down below or look it up on the Florida Department of Transportation Forms website.

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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

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

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