AGREEMENT between BROWARD COUNTY and Cummings ...

Exhibit 2
Page 365 of 379
FORM 3 FORM OF FINAL RECEIPT:
[The following form will be used to show receipt of final payment for this Agreement.]
Project Name: «T-4 Gate Replacement - Western Expansion»
Project Number: 3300
FINAL RECEIPT FOR CONTRACT NO. ________________________
Received this ______ day of __________________________, 20______, from Broward
County, the sum of ___________________ Dollars ($____________) as full and final payment
to CONTRACTOR for all work and materials for the Project described as:
This sum includes full and final payment for all extra work and material and all incidentals.
CONTRACTOR hereby indemnifies and releases Broward County from all liens and
claims whatsoever arising out of the Agreement and Project.
CONTRACTOR hereby certifies that all persons doing work upon or furnishing materials
or supplies for the Project have been paid in full. In addition to this certification regarding
payment for work, materials and supplies, CONTRACTOR may submit a consent of surety to
final payment in a form satisfactory to COUNTY.
CONTRACTOR further certifies that all taxes imposed by Chapter 212, Florida Statutes
(Sales and Use Tax Act), as amended, have been paid and discharged.
[If incorporated sign below.]
CONTRACTOR
ATTEST:
__________________________
Secretary
(CORPORATE SEAL)
_______________________________
(Name)
By_____________________________
Title
Date: ________________________
[If not incorporated sign below.]
Form of Final Receipt
CM @ Risk Agreement R0787918R1 040110 Page of 1 of 2