AFFIDAVIT. The undersigned swear or affirm that the foregoing statements are correct and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to the County current, complete and accurate information regarding actual joint venture work and the payment therefore and any proposed changes in any of the joint venture. Also, permit authorized representatives of the County to audit and examine records of the joint venture. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Name of Firm: Name of Firm: Signature: Signature: Name: Name: Title: Title: Date: Date: INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY – PAGE 4 Date State of County of AFFIDAVIT STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐ Personally Known; OR ☐ Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) ORANGE COUNTY, FLORIDA Procurement Division CONTRACT NO. Y22-1022 SHUTTLE BUS SERVICES FOR OCCC This contract is not valid unless bilaterally executed. Subject to mutual agreement Orange County, Florida, hereby enters into a contract subject to the following:
AFFIDAVIT. The undersigned swear or affirm that the foregoing statements are correct and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to the County current, complete and accurate information regarding actual joint venture work and the payment therefore and any proposed changes in any of the joint venture. Also, permit authorized representatives of the County to audit and examine records of the joint venture. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Name of Firm: Name of Firm: Signature: Signature: Name: Name: Title: Title: Date: Date: INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY – PAGE 4 Date State of County of On this AFFIDAVIT day of , 20 , before me appeared (name) , to me personally known, who being duly sworn, did execute the foregoing affidavit, and did state that he or she was properly authorized by (name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public Commission Expires (Seal) Date State of County of On this day of _ , 20 , before me appeared (name), to me personally known, who being duly sworn, did execute the foregoing affidavit, and did state that he or she was properly authorized by (name of firm) to execute the affidavit and did so as his or her free act and deed. Notary Public Commission Expires (Seal) ORANGE COUNTY BOARD OF Procurement Division COUNTY COMMISSIONERS CONTRACT NO. Y20-158 TEMPORARY LABOR FOR SKILLED GENERAL MAINTENANCE This contract is not valid unless bilaterally executed. Subject to mutual agreement Orange County, Florida, hereby enters into a contract subject to the following:
AFFIDAVIT. If the Agency-Assisted Contractor or Contractor(s) contend that the contract has been awarded to a SBE, the Agency-Assisted Contractor or Contractor(s) shall, at the same time also submit to the Agency a SBE Application for Certification and its accompanying Affidavit completed by the SBE owner. However, a SBE that was previously certified by the Agency shall submit only the short SBE Eligibility Statement.
AFFIDAVIT. I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at [Address of Affiant], after having been duly sworn in accordance with law, do hereby depose and state that:
AFFIDAVIT. An affidavit in the form required by the Escrow Agent to remove any standard exceptions from the Title Policy, including mechanics’ liens, parties in possession and similar matters, together with a GAP Indemnity.
AFFIDAVIT. The undersigned swear or affirm that the foregoing statements are correct and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to the County current, complete and accurate information regarding actual joint venture work and the payment therefore and any proposed changes in any of the joint venture. Also, permit authorized representatives of the County to audit and examine records of the joint venture. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Name of Firm: Name of Firm: Signature: Signature: Name: Name: Title: Title:
AFFIDAVIT. An affidavit in the form required by the Title Company to remove any standard exceptions, including mechanics’ liens, parties in possession and similar matters, together with a GAP Indemnity.
AFFIDAVIT. The undersigned, , as , and on behalf of , having been duly sworn under oath, certifies that in the year , it performed that portion of the Services described in Exhibit 1 of the Agreement in accordance with the terms of the Agreement, to the extent described in the attached Full-Year Assessment Form and that it spent that portion of funds obtained from the City in connection with that Agreement on the Services described in Exhibit 1, to the extent described in the attached Full-Year Assessment Form . The Full-Year Assessment Form shall be in the form prescribed by the City and shall contain such level of detail as the City may require from time to time. Nothing in this Affidavit may be construed as limiting Contractor’s obligations under the Agreement. All terms not defined in this Affidavit will be as defined in the Agreement. Under penalty of perjury, I certify that I am authorized to execute this Affidavit on behalf of the Contractor, that I have personal knowledge of the certifications made in this Affidavit, and that they are true and correct. NAME OF CONTRACTOR: Signature of Authorized Officer Name of Authorized Officer (Print or Type) State of County of Sworn to and acknowledged before me by [title] of contracting party] this day of , 20 . [name of signatory] as [name of Signature of Notary FULL-YEAR ASSESSMENT FORM THIS ITEM IS SATISFIED BY THE SUBMISSION OF ALL FOUR QUARTERLY REPORTS FOR THE CONTRACT YEAR EXHIBIT 8
AFFIDAVIT. The undersigned swear or affirm that the foregoing statements are correct and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to the County current, complete and accurate information regarding actual joint venture work and the payment thereforeand any proposed changes in any of the joint venture. Also, permit authorized representatives of the County to audit and examine records of the joint venture. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Name of Firm: ______________________ Name of Firm: ____________________ Signature: _________________________ Signature: _______________________ Name: ____________________________ Name: __________________________ Title: _____________________________ Title: ___________________________ Date: ____________________________ Date: ___________________________ Date _________________________ State of County of _________________________ AFFIDAVIT STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this _____ day of ________________, 20__, by __________________________________ [NAME OF PERSON], as ______________________________________ [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for _____________________________[NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐ Personally Known; OR ☐ Produced Identification. Type of identification produced _. [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] __________________________________ Notary Public My Commission Expires: __________________________________ (Printed, typed or stamped commissioned name of Notary Public) ORANGE COUNTY, FLORIDA and BUSINESS ASSOCIATE ADDENDUM TO CONTRACT NO. YXX-XXX related to BUSINESS ASSOCIATE ASSURANCE OF COMPLIANCE WITH THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) PRIVACY, BREACH AND SECURITY RULES AND THE FLORIDA INFORMATION PROTECTION ACT (FIPA) THIS ADDENDUM is by and between, ORANGE COUNTY, FLORIDA (the “County”), a charter county and political subdivision of the State of Florida, located at 000 Xxxxx Xxxxxxxx Xxxxxx, Orlando, Florida 32801, on behalf of its COUNTY DE...
AFFIDAVIT. The foregoing instrument was acknowledged before me this day of , 20 , by , Agent and Attorney-in-Fact of , who, is personally known to me or who has produced as identification and who did/did not take an oath. WITNESS my hand and official seal, this day of , 20 . (NOTARY SEAL) (Signature of person taking acknowledgment) (Name of officer taking acknowledgment) (Title or rank) (Serial number, if any) My commission expires:Click or tap here to enter text. FORM 5: UNCONDITIONAL LETTER OF CREDIT (PERFORMANCE AND PAYMENT GUARANTY) FORM UNCONDITIONAL LETTER OF CREDIT Date of Issue _ Issuing Bank’s No. _ Beneficiary: Applicant: _ Broward County, Amount: _ County Administrator (in United States Funds) Governmental Center, Room 409 000 Xxxxx Xxxxxxx Xxxxxx Expiry: _ Xxxx Xxxxxxxxxx, XX 00000 (Date) Bid/Contract Number _ We hereby authorize you to draw on (Bank, Issuer Name) _ at (Branch Address) _ by order of and for the account of _(Contractor, Applicant, Customer _ up to an aggregate amount, in United States Funds, of $ _ available by your drafts at sight, accompanied by: A signed statement from the County Administrator of Broward County, or the County Administrator’s authorized representative that the drawing is due to default in performance of certain obligations on the part of (Contractor, Applicant, Customer) agreed upon by and between Broward County and (Contractor, Applicant, Customer) pursuant to the Bid/Contract No. for (Name of Project) and Section 255.05, Florida Statutes. Drafts must be drawn and negotiated not later than (expiration date). Drafts must bear the clause: “Drawn under Letter of Credit No. (number), of (Bank name) )dated .” This Letter of Credit shall be renewed for successive periods of one (1) year each unless we provide the Broward County Administrator with written notice of our intent to terminate the credit herein extended, which notice must be provided at least thirty (30) days prior to the expiration date of the original term hereof or any renewed one (1) year term. Notification to Broward County that this Letter of Credit will expire prior to performance of Contractor’s obligations will be deemed a default. This Letter of Credit sets forth in full the terms of our undertaking, and such undertaking shall not in any way be modified or amplified by reference to any documents, instrument, or agreement referred to herein or in which this Letter of Credit is referred to or this Letter of Credit relates, and any such reference shall not ...
