Form 700-011-17 Design-Build-Finance Firm Request for Direct Payment to Firm's Primary Vendor Account for All Department Payments to Be Made on Contract - Florida

Form 700-011-17 or the "Design-build-finance Firm Request For Direct Payment To Firm's Primary Vendor Account For All Department Payments To Be Made On Contract" is a form issued by the Florida Department of Transportation.

Download a PDF version of the Form 700-011-17 down below or find it on the Florida Department of Transportation Forms website.

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700-011-17
CONSTRUCTION
OGC – 07/18
Page 1 of 2
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
DESIGN-BUILD-FINANCE
FIRM REQUEST FOR DIRECT PAYMENT
TO FIRM’S PRIMARY VENDOR ACCOUNT FOR ALL DEPARTMENT
PAYMENTS TO BE MADE ON CONTRACT #
[Firm Name] (hereinafter “DBF
Firm”), the Design-Build-Finance Firm contracting with the Florida Department of Transportation (hereinafter
“Department”) pursuant to Contract #
, FIN #
, and here doing so
solely for the DBF Firm’s benefit and in furtherance of independent arrangements the DBF Firm has made with its Lender,
(hereinafter “Lender”) and Surety,
(hereinafter “Surety”), hereby expressly
and irrevocably requests, authorizes and directs the Department to process, issue and transmit any and all future
payments directly to the DBF Firm, in lieu of the contractual requirement for establishment of a DBF Firm Project Specific
Escrow Account for this Contract, as follows:
A. DIRECT PAYMENT TO FIRM DIRECTIONS: DBF Firm has duly established with MyFlorida Marketplace a
Primary Vendor Account to which DBF Firm requests all future payments on this Contract be processed, issued
and transmitted, as follows:
1.
DBF Firm’s Primary Vendor Account “Firm Payee Name,” is
.
2.
DBF Firm’s Primary Vendor Account vendor number sequence is
.
3.
DBF Firm’s Primary Vendor Account mailing address for such Primary Vendor Account vendor
number sequence is:
(DBF Firm Name)
(Continued)
(Continued)
(Address and Street)
(City, State, Zip)
4.
DBF Firm acknowledges that all such direct payments will be made by electronic transfer only if
currently or subsequently established with the Department of Financial Services, and in lieu
thereof such direct payments will be made by warrant and shall be mailed directly to the address
in (3) above.
B. GENERAL TERMS:
1.
DBF Firm understands and agrees that the Department will require reasonable time to respond
and initiate any requested changes in the payee vendor number sequencing under this Contract;
and, further, the Department shall have no liability, whatsoever, for any delay in processing any
such payee change as set forth above prior to expiration of fourteen (14) business days following
the Department’s certified, return-receipt or registered mail receipt of DBF Firm’s formal request.
DBF Firm agrees hereby to indemnify, defend, and hold-harmless the Department from any
cause of action, suit, claim or other demand made against the Department arising in any way out
of the Department’s failure to process any such payee vendor number sequencing change as set
700-011-17
CONSTRUCTION
OGC – 07/18
Page 1 of 2
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
DESIGN-BUILD-FINANCE
FIRM REQUEST FOR DIRECT PAYMENT
TO FIRM’S PRIMARY VENDOR ACCOUNT FOR ALL DEPARTMENT
PAYMENTS TO BE MADE ON CONTRACT #
[Firm Name] (hereinafter “DBF
Firm”), the Design-Build-Finance Firm contracting with the Florida Department of Transportation (hereinafter
“Department”) pursuant to Contract #
, FIN #
, and here doing so
solely for the DBF Firm’s benefit and in furtherance of independent arrangements the DBF Firm has made with its Lender,
(hereinafter “Lender”) and Surety,
(hereinafter “Surety”), hereby expressly
and irrevocably requests, authorizes and directs the Department to process, issue and transmit any and all future
payments directly to the DBF Firm, in lieu of the contractual requirement for establishment of a DBF Firm Project Specific
Escrow Account for this Contract, as follows:
A. DIRECT PAYMENT TO FIRM DIRECTIONS: DBF Firm has duly established with MyFlorida Marketplace a
Primary Vendor Account to which DBF Firm requests all future payments on this Contract be processed, issued
and transmitted, as follows:
1.
DBF Firm’s Primary Vendor Account “Firm Payee Name,” is
.
2.
DBF Firm’s Primary Vendor Account vendor number sequence is
.
3.
DBF Firm’s Primary Vendor Account mailing address for such Primary Vendor Account vendor
number sequence is:
(DBF Firm Name)
(Continued)
(Continued)
(Address and Street)
(City, State, Zip)
4.
DBF Firm acknowledges that all such direct payments will be made by electronic transfer only if
currently or subsequently established with the Department of Financial Services, and in lieu
thereof such direct payments will be made by warrant and shall be mailed directly to the address
in (3) above.
B. GENERAL TERMS:
1.
DBF Firm understands and agrees that the Department will require reasonable time to respond
and initiate any requested changes in the payee vendor number sequencing under this Contract;
and, further, the Department shall have no liability, whatsoever, for any delay in processing any
such payee change as set forth above prior to expiration of fourteen (14) business days following
the Department’s certified, return-receipt or registered mail receipt of DBF Firm’s formal request.
DBF Firm agrees hereby to indemnify, defend, and hold-harmless the Department from any
cause of action, suit, claim or other demand made against the Department arising in any way out
of the Department’s failure to process any such payee vendor number sequencing change as set
700-011-17
CONSTRUCTION
OGC – 07/18
Page 2 of 2
forth above, if the Department does so as set forth above prior to the expiration of fourteen (14)
business days following the Department’s certified, return-receipt or registered mail receipt of the
appropriate formal request.
2.
By signature below, Lender and Surety, in their respective capacities, understand, consent to,
and agree to be so bound by the entirety of the terms of this Design-Build-Finance Firm Request
for Direct Payment to DBF Firm’s Primary Vendor Account.
3.
This request is irrevocable by DBF Firm, subject to DBF Firm obtaining written concurrence by
both its named Lender and Surety, and acceptance by the Department of any such subsequent
request to change from this Direct Payment to DBF Firm’s Primary Vendor Account vendor
number sequence for the processing, issuance and transmittal of payments due under this
Contract.
4.
The fully executed original of this Request Form #700-011-17 must be delivered to the District
Construction Engineer, and a copy of the fully executed Request Form also delivered to “FDOT
Comptroller, 605 Suwannee Street MS #24, Tallahassee, Florida 32399-0424.”
DESIGN-BUILD-FINANCE FIRM
(Signature)
(Printed Name of Signator)
(Official Capacity)
(Date of Signature)
LENDER
SURETY
(Signature)
(Signature)
(Printed Name of Signator)
(Printed Name of Signator)
(Official Capacity)
(Official Capacity)
(Date of Signature)
(Date of Signature)

Download Form 700-011-17 Design-Build-Finance Firm Request for Direct Payment to Firm's Primary Vendor Account for All Department Payments to Be Made on Contract - Florida

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