Fillable Contractor Affidavit material used in the construcon of (Hillsborough County)

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Contractor Affidavit material used in the construcon of (Hillsborough County)

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File type: PDF

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____________________________________
________________________________________________________________
Development Services
Contractor Affidavit
I/We as contractor for the construcon of the improvement facilies ______________________________
for ___________________________________, having been rst duly sworn, depose and say: That all the
material used in the construcon of the facilies meet the requirements of the Hillsborough County Water
and Wastewater Technical Manual Specicaons, the Highway and Bridge Technical Manual, and the Florida
Department of Transportaon Standard Specicaons for Road and Bridge Construcon, latest edion.
By:
__________________________________
Signature
Print name and tle ____________________
Company: ____________________________
Address: _____________________________
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
The foregoing instrument was acknowledged before me by means of
physical presence or
online notarizaon, this
________ day of __________________________________ , _________________ , by___________________________________________________ .
(day) (month) (year) (name of person acknowledging)
Personally Known OR
Produced Idencaon _________________________________________________________________
(Signature of Notary Public - State of Florida)
____________________________________________________
Type of Idencaon Produced
_________________________________________________________________
(Print, Type, or Stamp Commissioned Name of Notary Public)
(Notary Seal) (Commission Number) (Expiraon Date)
7/2020
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Contractor Affidavit material used in the construcon of (Hillsborough County)

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Completed 30 December 2021

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