North Dakota Department of Transportation · North Dakota state form
SFN 58393 Fuel Cost Adjustment Affidavit
Contractors use this affidavit to elect whether to participate in a fuel cost adjustment and report estimated diesel fuel costs for a contract.
- What this form is
- SFN 58393 asks the contractor whether the company elects to participate in the fuel adjustment for the contract and, if so, to provide estimated diesel fuel costs. The contractor must return the affidavit for contracts with the fuel cost adjustment provision, even if not participating. The form includes a certification, signature and date fields, and a notary or authorized officer acknowledgment.
- Who needs it
- A contractor with a contract containing the fuel cost adjustment provision must return this affidavit, whether or not the company elects to participate.
- Why it needs a notary
- The legal signature must be signed before a Notary Public or Authorized Officer. Online notarization is available with a commissioned online notary.
- How to submit it
- Return the affidavit for all contracts with the fuel cost adjustment provision. The form does not specify a submission address or method.
Questions
Who must return SFN 58393?
The contractor must return the affidavit for every contract with the Fuel Cost Adjustment Clause, even if the company elects not to participate in the program.
Does the contractor have to elect to participate?
No. The form asks whether the company elects to participate. It also says the contractor must return the affidavit even when it elects not to participate.
Does SFN 58393 need to be notarized?
Yes. The form says to sign the legal signature before a Notary Public or Authorized Officer and provides an acknowledgment section for the notary or officer.