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v. <br /> IMF <br /> In <br /> 14 <br /> n In <br /> In <br /> IW <br /> STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION In <br /> 70ITQel <br /> ,y6 <br /> CERTIFICATION OF SUBLET WORK CON$TRUCTtrOIN <br /> In <br /> TO: THE STATE OF FLORIDA DEPARTMENT OF TRANSPORTATIONIII v II In In <br /> d �_ W°7 <br /> Date: 7/1 /11 nl General Info G 4ll{NC _ " r ;, sea <br /> ' <br /> In <br /> In RAP Not No I In <br /> , Prime Contractor CD actorIAI <br /> i s v �� 4 t <br /> Fin . Proj . ID : j7rA4 423t$b - 1 -58- o t � s� ✓ ' Z� . ay: — 1/� '' <br /> Cont No . : <br /> F. E . LD . # C PORATION , AFFIX 'Se,4,1 , t, ' <br /> Count : I NR� Ifea Ste( - 2 $120b t4 Ci � Co C1JIn <br /> Crxt �.• kIn %In <br /> In In <br /> Total Contract Amount AddressI In <br /> — " <br /> Total Work <br /> 11 %1 I I Inv <br /> FREEMEN <br /> I In <br /> '� Subcontractor Name �= FEI D # Subcontract to Whom Work Description Total Amt m,It <br />o <br /> n > Sublet Q On <br /> /aL F�2p Ccr(us'tRticn �Jr rNC - gt -234183 //�1 /� � �/� �, / <br /> 1 11 In <br /> 3 l� Pw� r VClAI<uVrft h�ANQRA ( tb5 <br /> KEnj AtsnrJ Carl On) � ,7i•3c. � Rr� Sf t9c wAt3 �f5 rnf6v oa � <br /> (tel � viRvN /11GrTAi� , .Llu� r �sv,J Ori %CNC CfoS(on lon� tra � LS�011& ,, a � g IS. as 4(?s- <br /> Lin, 11 5 - , 1✓ rNUr .1W G. f NCS �S( A�aG 10 0 �. �5 O� <br /> RElr mel UMocR t l� nx, L �� . t Z� 41 n �►� • UN rou ll+, l ch �s 9F Int I <br /> 0 . °I i <br /> LS p Nuasu�- 1 <br /> MAO �n,;F sForrNC moo . AjW <br /> 07a rpiw CoAa,;M 64 <br /> All pertinent provisions and requirements of the prime contract including but not limited to Required Contract Total <br /> �j r 5 <br /> Provisions Federal•Aid Construction Contracts (FHWA-1273) and Special Provisions - Specific Equal Opportunity s�� <br /> 6 <br /> Responsibilities (Per 23 CFR-8339 or Federai•Atd Poilcy Guide) will be part of the subcontracL It is agreed that an State of FlOri <br /> Executed or a certified copy of the subcontract will be submitted upon request, to the State of Florida Department of County Of Q r <br /> I <br /> Transportation . All sublets will be In continued compliance with all Contract provisions and that the Contractor w81 <br /> continue to perform the minimum percentage of Contract work with its own organization , as required by said <br /> Contract. It is recognized and agread that , as prime contractor, the undersigned remains responsible for the proper Sworn t and subscribed <br /> before me this day <br /> performance of all requirements of said contract does not relfeve or release the undersigned and his surety or either Of I <br /> by <br /> In I <br /> In <br /> O of them of any liability under the contract bond. The Contractor shell send a copy of this form to the subcontractor/ <br /> p subordinate (with a copy of FHWA-1273 on Fedaral•Ald Projects) and the Surety Company. The Prima certify that ;( <br /> rint Fnam Of person signing Certification ) In <br /> U1 firms or Individuals, debarred or suspended by the FHWA or the Department, are not being used as subcontractors. Znr'' <br /> I AITH HEMRIC <br />, I nenO <br /> N018 Ub r 'P ^O10MISS10N N DD 8791601 I 'll FF <br /> A false statement or omission made in connection with this certification Is sufficient cause for susIn III I " In <br /> pension , CXi- iFIES August 9, 2013 <br /> F^' revocation, or dental of qualification to bid, and a determination of non•responsiblllty, and may subject the person Commission Expires <br /> � �Xf, t • �r 'eJ ? I ru Notary Public Underwriters <br /> and/or entity making the raise statement to any and all civil and criminal penalties available pursuant to applicable <br /> c <br /> Federal and state Law. Personally Known OR Produced Identification <br /> Type of Identification Produced <br />