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F FLORIDA D � �e <br /> 700-010-36 <br /> t __ <br /> OJ <br /> CONSTRUCTION s^ <br /> STATE O DEPARTMENT OF TRANSPORTATION 1C/07 �F� <br /> T WORK I� <br /> CERTIFICATION ®F <br /> SUBLET <br /> (Seal! <br /> -O: THE SATE OF FLGRIDA DEPARTMENT OF TRANSPORTATION General Info Contractor q <br /> t r ` <br /> Date: Prime Contractor Ia: <br /> Request No.: �j <br /> Q p D (� By IF CORPORATION,AFFIX SEAL I <br /> FAP No.:,' � c� .._�.,� <,,.. � � <br /> F.E.�,D_# r <br /> ivu <br /> Fin- Proj. ID: Z � ' �'T ' <br /> �" <br /> Cont. No-! GZ�_ Z _ Address <br /> County: ��Y—r ,d,EA/ <br /> Total Contract Amount <br /> Total 2 W <br /> 2 © _ - Total Amt <br /> FEID# Subcontract to Whom <br /> Work Description :�` Sublet z <br /> Subcontractor Name <br /> L" l <br /> Ce <br /> t <br /> I <br /> i <br /> i <br /> Totaling but not I <br /> d to <br /> Contract <br /> All pertinent provisions and requirements of the FHmVIcontract in lupe ial P ovisionls-Specific Equal Opportunity <br /> Provisions Federal-Aid Construction Contracts( County Of ^ <br /> twill be submitted upon request,to the State of Florida Department of <br /> Responsibilities(Per 23 CFR-6338 of Fede ac-AId Policy Guide)will be part of the subcontract. It is agreed that an State of Florida <br /> of the subcontract day <br /> Executed or a certified copy Mance with all Contract provisions and that the ts own organization, by Contractor will <br /> Transportation. All sublets wall be in continued compliance Sworn t0 and subscribed before me this <br /> o <br /> 1�\(� [ by �1�(1 �` <br /> continue to perform the minimum that,aspnmetcont actorWthelunders undersigned roma ns responsible for the proper <br /> Contract. It is recognized and agreedat. ease (Frint''name of p son signing Certification) <br /> does not relieve or of this form to the subcontractor/ of <br /> performance of all requirements of said contract bond. TheContractor shall send a copy of this and his surety or either _} A <br /> of them of any liability under the <br /> subordinate(with a copy of FHWA 7273 on Federal-AId Projects)and the Surety Company. The Prime certify that 4NOtOP�ubllc, Vit`' r EE13�ez <br /> firms or individuals,debarred or suspended by the FHWA or the Department,are not being used as subcontractors. I ` 0 C <br /> nor r.<; ;-03,2015 <br /> subject the person <br /> Commission Expires t sa+canav Fi.rm� yU. <br /> I A false statement or omission made in connection with this certification is sufficient cause for suspension. (;cable � OR Produce e <br /> revocation,or denial of qualification to bid,and a determiriation of non-responsibility,and may Personally Known <br /> and/or entity making the false statement to any and all civil and criminal penalties available pursuant to applicable Type of Identification Produced <br /> Federal and State Law. <br />