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SECTION 00500 <br /> STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 700-010- <br /> CERTIFICATION OF SUBLET WORK CONSTRUCTIC <br /> 10i <br /> TO: THE STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION <br /> Date: t e.,ti 4 .1 , General Info ,¢ (Seal) <br /> Request No,: Prime Contractor Contractor <br /> FAP No.: \acs By: <br /> Fin. Proj. 1D: � ._ _ <br /> Cont. No.: E.I.D.# IF CORPORATION,AFFIX SEAL <br /> Count eL-, <�\i 114tQ_ V ~ <br /> Address L <br /> Total Contract Amount <br /> y <br /> Total Work <br /> Subcontractor Name •. Total Amt c <br /> 1- FEID# Subcontract to Whom Work Description �: z <br /> ,Z> Sublet p:� <br /> All pertinent provisions and requirements of the prime contract including but not limited to Required Contract Total <br /> Provisions Federal-Aid Construction Contracts(FHWA-1273)and Special Provisions-Specific Equal Opportunity <br /> Responsibilities(Per 23 CFR-6333 of Federal-Aid Policy Guide)will be part of the subcontract. It is agreed that an State of Florida •, ` <br /> Executed or a certified copy of the subcontract will be submitted upon request,to the State of Florida Department of County of <br /> Transportation. All sublets will be in continued compliance with all Contract provisions and that the Contractor will r <br /> continue to perform the minimum percentage of Contract work with its bwn organization,as required by said Sworn to and subscribed before me this day <br /> Contract. It is recognized and agreed that,as prime contractor,the undersigned remains responsible for the proper .s � <br /> performance of all requirements of said contract does not relieve or release the undersigned and his surety or either of QXUA , Z{,(0by �r <br /> 0 of them of any liability under the contract bond. The Contractor shall send a copy of this form to the subcontractor/ / ( S QJff{i Ertlflcaflcn <br /> 0 subordinate(with a copy of FHWA-1273 on Federal-Aid Projects)and the Surety Company. The Prime certify that ��{;� 2oravP�ecn v�� I <br /> In firms or individuals,debarred or suspended by the FHWA or the Department,are not being used as subcontractors. DEBORAH <br /> Notate 11bIIC MY COMMISSION 9FF9ST <br /> 0 �� oPP EXPIRES.October 03,2019 <br /> 1 A false statement or omission made in connection with this certification is sufficient cause for suspension, lin 111 k9 cFw <br /> I—+ revocation,or denial of qualification to bid,and a determination of non responsibility,and may subject the person Commission Expires <br /> and/or entity making the false statement to any and all civil and criminal penalties available pursuant to applicable personally Known , OR Produced Identification <br /> Federal and State Law. <br /> Type of Identification Produced <br />