Common use of Certificate of Payment Clause in Contracts

Certificate of Payment. Contract No. ITB #2025-4 Project (Name and Address): NE 26TH STREET ROADYWAY IMPROVEMENTS PROJECT oceed Date: To (Municipality): City of Wilton Manors, Florida Consultant: Contractor: Notice to Pr Consultant: Date of Issuance: All conditions or requirements of any permits or regulatory agencies have been satisfied. The documents required pursuant to the terms and conditions of the Contract, and the final bill of materials, if required, have been received and accepted. The Work required by the Contract Documents has been reviewed and the undersigned certifies that the Work, including minor corrective work, has been completed in accordance with the provision of the Contract Documents and is accepted under the terms and conditions thereof. Consultant By Date Municipality, through its Municipality Manager, accepts the work as fully complete and will assume full possession thereof at on . (time) (date) MUNICIPALITY OF THE CITY OF WILTON MANORS: By Municipality Manager Date [The following form will be used to show receipt of final payment for this Contract.] Received this day of , 20 , from the Municipality of THE CITY OF WILTON MANORS, Florida, the sum of Dollars ($ ) as full and final payment to Contractor for all work and materials for the Project described as: NE 26TH STREET ROADYWAY IMPROVEMENTS PROJECT This sum includes full and final payment for all extra work and material and all incidentals. Contractor hereby indemnifies and releases the Municipality of the City of Wilton Manors from all liens and claims whatsoever arising out of the Contract and/or Project. Contractor hereby certifies that all persons doing work upon or furnishing materials or supplies for the Project have been paid in full. In lieu of this certification regarding payment for work, materials and supplies, Contractor may submit a consent of surety to final payment in a form satisfactory to the Municipality of City of Wilton Manors. Contractor further certifies that all taxes imposed by Chapter 212, Florida Statutes (Sales and Use Tax Act), as amended, have been paid and discharged. ATTEST: CONTRACTOR NAME Corporate Secretary or other person authorized to attest (CORPORATE SEAL OR NOTARY) By: Authorized Signer Print Name and Title day of , 20 WITNESSES: Witness signature Print/Type Name Business Name By: Authorized Signer Print/Type Name and Title Witness signature day of , 20 Print/Type Name To: “CONTRACTOR”, Contractor From: Broward County Purchasing Division Subject: Final List of Non-certified Subcontractors/Sub-vendors Re: NE 26TH STREET ROADYWAY IMPROVEMENTS PROJECT, ITB #2025-4 (Project Title, Contract Number) The attached list of non-certified Subcontractors/sub-vendors have performed or provided services to Municipality for the referenced contract. Non-certified Subcontractors/sub-vendors are any Subcontractors/sub-vendors whose services under the Contract were not approved to meet the participation CBE/SBE goal establshed for this Contract, and whose participation was not listed on Contractor’s “Schedule of Participation” and/or not aproved as substitutes or additions by the Broward County Office of Economic Small Business Development Division toward meeting the established goal. Contractor certifies the following: There were no other non-certified Subcontractors/sub-vendors who provided a service to Municipality for the referenced Contract. All participants on the Contract are listed on the attached list. There were other non-certified Subcontractors/sub-vendors who provided a service and are not listed on the attached list. The additional Subcontractors/sub-vendors are listed on the attached list. THE UNDERSIGNED VENDOR HEREBY CERTIFIES THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND CORRECT. STATE OF COUNTY OF The foregoing Final List of Non-Certified Subcontractors and Suppliers was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this day of , 20 , by . (NOTARY SEAL) Signature: Print Name: My commission expires: ☐ Personally Known or ☐ Produced Identification Type of Identification Produced: _ Project Name: NE 26TH STREET ROADYWAY IMPROVEMENTS PROJECT Project Number: ITB #2025-4 From (Name of Proposer/Bidder): Firm Address: Project Description: In response to Municipality’s RLI/RFP/Bid No. 2025-1 the undersigned hereby agree to utilize the CBE or SBE firm listed below, if awarded the contract. The undersigned further certify that the firm has been contacted and properly apprised of the projected work assignment(s) upon execution of the contract with Municipality. Name of CBE/SBE Firm: Address of CBE/SBE Firm: Expiration of CBE/SBE Certification: Projected CBE/SBE Work Assignment (description of work assignment): Projected Percentage of Prime’s Contract Fees to be Awarded to CBE/SBE: % (Signature of Owner or Authorized Rep. Prime) (Date) Print Name (owner or authorized Rep. Prime): STATE OF COUNTY OF The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this day of , 20 , by My commission expires: NOTARY PUBLIC: Signature: Print Name: (NOTARY SEAL) ☐ Personally Known or ☐ Produced Identification Type of ID Produced: The undersigned intends to perform Work in connection with the above Contract as (check one): an individual a partnership a corporation a joint venture. The undersigned agrees with the prime contractor’s/consultant’s proposal and further certifies that all information provided herein is true and correct. (Signature of Owner or Authorized Rep. CBE/SBE) (Date) Print Name (owner or authorized Rep. CBE/SBE): STATE OF COUNTY OF The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this day of , 20 , by My commission expires: NOTARY PUBLIC: Signature: Print Name: (NOTARY SEAL) ☐ Personally Known or ☐ Produced Identification Type of Identification Produced: (Company Letterhead) I, (Authorized Official/Agent), on behalf of the (Contractor), hereby agree to comply with the County Business Enterprise (CBE) or Small Business Enterprise (SBE) requirements of the RFP between the Municipality of and Contractor for Project, and to comply with the following requirements. 1. Compliance with the Municipality’s non-discrimination policy by providing a non- discrimination Statement; 2. Acknowledgment of the CBE/SBE percentage goal established on the project; and 3. Contract to engage in good faith effort solicitation of approved Broward County Small Business Development Program firms to achieve the project goals as indicated in the RFP document.

Certificate of Payment. Contract No. ITB #2025-4 1 Project (Name and Address): NE 26TH STREET ROADYWAY IMPROVEMENTS PROJECT Wilton Manors Wayfinding Program oceed Date: To (Municipality): City of Wilton Manors, Florida Consultant: Contractor: Notice to Pr Consultant: Date of Issuance: All conditions or requirements of any permits or regulatory agencies have been satisfied. The documents required pursuant to the terms and conditions of the Contract, and the final bill of materials, if required, have been received and accepted. The Work required by the Contract Documents has been reviewed and the undersigned certifies that the Work, including minor corrective work, has been completed in accordance with the provision of the Contract Documents and is accepted under the terms and conditions thereof. Consultant By Date Municipality, through its Municipality Manager, accepts the work as fully complete and will assume full possession thereof at on . (time) (date) MUNICIPALITY OF THE CITY OF WILTON MANORS: By Municipality Manager Date [The following form will be used to show receipt of final payment for this Contract.] Received this day of , 20 , from the Municipality of THE CITY OF WILTON MANORS, Florida, the sum of Dollars ($ ) as full and final payment to Contractor for all work and materials for the Project described as: NE 26TH STREET ROADYWAY IMPROVEMENTS PROJECT Wilton Manors Wayfinding Program This sum includes full and final payment for all extra work and material and all incidentals. Contractor hereby indemnifies and releases the Municipality of the City of Wilton Manors from all liens and claims whatsoever arising out of the Contract and/or Project. Contractor hereby certifies that all persons doing work upon or furnishing materials or supplies for the Project have been paid in full. In lieu of this certification regarding payment for work, materials and supplies, Contractor may submit a consent of surety to final payment in a form satisfactory to the Municipality of City of Wilton Manors. Contractor further certifies that all taxes imposed by Chapter 212, Florida Statutes (Sales and Use Tax Act), as amended, have been paid and discharged. ATTEST: CONTRACTOR NAME Corporate Secretary or other person authorized to attest (CORPORATE SEAL OR NOTARY) By: Authorized Signer Print Name and Title day of , 20 WITNESSES: Witness signature Print/Type Name Business Name By: Authorized Signer Print/Type Name and Title Witness signature day of , 20 Print/Type Name To: “CONTRACTOR”, Contractor From: Broward County Purchasing Division Subject: Final List of Non-certified Subcontractors/Sub-vendors Re: NE 26TH STREET ROADYWAY IMPROVEMENTS PROJECT, ITB #2025-4 (Project Title, Contract Number) The attached list of non-certified Subcontractors/sub-vendors have performed or provided services to Municipality for the referenced contract. Non-certified Subcontractors/sub-vendors are any Subcontractors/sub-vendors whose services under the Contract were not approved to meet the participation CBE/SBE goal establshed for this Contract, and whose participation was not listed on Contractor’s “Schedule of Participation” and/or not aproved as substitutes or additions by the Broward County Office of Economic Small Business Development Division toward meeting the established goal. Contractor certifies the following: There were no other non-certified Subcontractors/sub-vendors who provided a service to Municipality for the referenced Contract. All participants on the Contract are listed on the attached list. There were other non-certified Subcontractors/sub-vendors who provided a service and are not listed on the attached list. The additional Subcontractors/sub-vendors are listed on the attached list. THE UNDERSIGNED VENDOR HEREBY CERTIFIES THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND CORRECT. STATE OF COUNTY OF The foregoing Final List of Non-Certified Subcontractors and Suppliers was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this day of , 20 , by . (NOTARY SEAL) Signature: Print Name: My commission expires: ☐ Personally Known or ☐ Produced Identification Type of Identification Produced: _ Project Name: NE 26TH STREET ROADYWAY IMPROVEMENTS PROJECT Project Number: ITB #2025-4 From (Name of Proposer/Bidder): Firm Address: Project Description: In response to Municipality’s RLI/RFP/Bid No. 2025-1 the undersigned hereby agree to utilize the CBE or SBE firm listed below, if awarded the contract. The undersigned further certify that the firm has been contacted and properly apprised of the projected work assignment(s) upon execution of the contract with Municipality. Name of CBE/SBE Firm: Address of CBE/SBE Firm: Expiration of CBE/SBE Certification: Projected CBE/SBE Work Assignment (description of work assignment): Projected Percentage of Prime’s Contract Fees to be Awarded to CBE/SBE: % (Signature of Owner or Authorized Rep. Prime) (Date) Print Name (owner or authorized Rep. Prime): STATE OF COUNTY OF The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this day of , 20 , by My commission expires: NOTARY PUBLIC: Signature: Print Name: (NOTARY SEAL) ☐ Personally Known or ☐ Produced Identification Type of ID Produced: The undersigned intends to perform Work in connection with the above Contract as (check one): an individual a partnership a corporation a joint venture. The undersigned agrees with the prime contractor’s/consultant’s proposal and further certifies that all information provided herein is true and correct. (Signature of Owner or Authorized Rep. CBE/SBE) (Date) Print Name (owner or authorized Rep. CBE/SBE): STATE OF COUNTY OF The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this day of , 20 , by My commission expires: NOTARY PUBLIC: Signature: Print Name: (NOTARY SEAL) ☐ Personally Known or ☐ Produced Identification Type of Identification Produced: (Company Letterhead) I, (Authorized Official/Agent), on behalf of the (Contractor), hereby agree to comply with the County Business Enterprise (CBE) or Small Business Enterprise (SBE) requirements of the RFP between the Municipality of and Contractor for Project, and to comply with the following requirements. 1. Compliance with the Municipality’s non-discrimination policy by providing a non- discrimination Statement; 2. Acknowledgment of the CBE/SBE percentage goal established on the project; and 3. Contract to engage in good faith effort solicitation of approved Broward County Small Business Development Program firms to achieve the project goals as indicated in the RFP document.