Form 700-011-16 Design-Build-Finance Firm Request for Project Specific Escrow Account and Unique Vendor Number Sequence for All Department Payments to Be Made on Contract - Florida

Form 700-011-16 or the "Design-build-finance Firm Request For Project Specific Escrow Account And Unique Vendor Number Sequence For All Department Payments To Be Made On Contract" is a form issued by the Florida Department of Transportation.

The form was last revised in July 1, 2018 and is available for digital filing. Download an up-to-date Form 700-011-16 in PDF-format down below or look it up on the Florida Department of Transportation Forms website.

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700-011-16
CONSTRUCTION
OGC – 07/18
Page 1 of 2
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
DESIGN-BUILD-FINANCE FIRM REQUEST FOR PROJECT SPECIFIC
ESCROW ACCOUNT AND UNIQUE VENDOR NUMBER SEQUENCE 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 otherwise payable directly to DBF Firm to now be processed, issued and transmitted using DBF Firm’s Project
Specific Escrow Account and unique vendor number sequence, in lieu of DBF Firm’s regular vendor account, as follows:
A. PROJECT SPECIFIC ESCROW ACCOUNT DIRECTIONS: DBF Firm requests all future payments on this
Contract be processed, issued and transmitted, based on the following information:
1.
DBF Firm’s vendor number (FEID) is
.
2.
DBF Firm hereby requests the Department’s Comptroller coordinate establishment of a unique
vendor number sequence for this Project Specific Escrow Account with
MyFloridaMarketplace/Department of Financial Services.
3.
DBF Firm’s Project Specific Escrow Account mailing address will be:
(DBF Firm Name)
(Continued)
(Continued)
(Address and Street)
(City, State, Zip)
4.
DBF Firm acknowledges that all such Project Specific Escrow Account payments will be made by
written 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 as a result of a change 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
twenty (20) 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 forth above, if the Department does so as set forth above prior
to the expiration of twenty (20) business days following the Department’s certified, return-receipt
or registered mail receipt of the appropriate formal request.
700-011-16
CONSTRUCTION
OGC – 07/18
Page 1 of 2
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
DESIGN-BUILD-FINANCE FIRM REQUEST FOR PROJECT SPECIFIC
ESCROW ACCOUNT AND UNIQUE VENDOR NUMBER SEQUENCE 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 otherwise payable directly to DBF Firm to now be processed, issued and transmitted using DBF Firm’s Project
Specific Escrow Account and unique vendor number sequence, in lieu of DBF Firm’s regular vendor account, as follows:
A. PROJECT SPECIFIC ESCROW ACCOUNT DIRECTIONS: DBF Firm requests all future payments on this
Contract be processed, issued and transmitted, based on the following information:
1.
DBF Firm’s vendor number (FEID) is
.
2.
DBF Firm hereby requests the Department’s Comptroller coordinate establishment of a unique
vendor number sequence for this Project Specific Escrow Account with
MyFloridaMarketplace/Department of Financial Services.
3.
DBF Firm’s Project Specific Escrow Account mailing address will be:
(DBF Firm Name)
(Continued)
(Continued)
(Address and Street)
(City, State, Zip)
4.
DBF Firm acknowledges that all such Project Specific Escrow Account payments will be made by
written 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 as a result of a change 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
twenty (20) 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 forth above, if the Department does so as set forth above prior
to the expiration of twenty (20) business days following the Department’s certified, return-receipt
or registered mail receipt of the appropriate formal request.
700-011-16
CONSTRUCTION
OGC – 07/18
Page 2 of 2
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 Specific Escrow Account and Unique Vendor Number Sequence.
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 Project Specific Escrow Account and unique vendor number
sequence for the processing, issuance and transmittal of payments due under this Contract.
4.
The fully executed original of this Request Form #700-011-16 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 700-011-16 Design-Build-Finance Firm Request for Project Specific Escrow Account and Unique Vendor Number Sequence for All Department Payments to Be Made on Contract - Florida

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