AFFIDAVIT OF BILLS PAID
AND PARTIAL WAIVER OF LIEN
(Progress Payment)
STATE OF
COUNTY OF
BEFORE ME, the undersigned authority, personally appeared ,
who upon his oath, deposed and stated the following:
1.My name is . I am
of (“Contractor”). I have knowledge of the facts set forth below and am competent and authorized to make this affidavit.
2.DRAW AMOUNT, $ , dated , 20 , is a true and complete account of the sums owed to Contractor for labor or materials or both furnished by Contractor under the terms of the contract between Contractor relating to the construction of improvements at Apartments, owned by Owner and represents the actual value of such labor or materials or both to date.
3.There are no known mechanics’ liens or materialmen’s liens outstanding as of the date hereof relating to or arising out of the furnishing of labor or materials or both by Contractor or his Suppliers for the above described improvements.
4.All due and payable bills with respect to the materials and labor used in connection with Contractor’s performance under its contract with Owner have been paid to date or are included in the Voucher. Exhibit “A” attached hereto and made a part hereof lists all of Contractor’s sub-contractors and suppliers, all of whom have been paid in full as to bills due and payable through the date hereof, less applicable retention.
5.Except for such bills not paid but included in the Voucher, there is no known basis for the filing of any mechanics’ or materialmen’s liens.
6.Contractor has complied with all federal, state or local tax laws, unemployment compensation laws, workmen’s compensation laws and federal wage and hours laws, insofar as applicable to the performance of such contract.
7.Further, in consideration of the payments received, and upon receipt of the amount shown on the Voucher, less applicable retainage, Contractor does hereby waive, release and relinquish all claim or right of lien, constitutional or statutory, which Contractor may now have upon the above described property except for claims or right of lien of Contract and/or Change Order work performed to the extent that payment is being retained or subsequently becomes due. Contractor agrees to hold harmless from any liability and to reimburse Owner and Owner’s agents for all their costs, expenses and reasonable attorney’s fees, on any claims hereinafter made in connection with said contract with owner or any work performed by sub-contractor on said improvements whether or not said work is now covered by the Voucher.
EXECUTED THIS DAY OF , 20 .
BY:
Contractor NameTitle
SUBSCRIBED AND SWORN TO BEFORE ME UNDER MY OFFICIAL SEAL OF OFFICE THIS
DAY OF , 20 .
Notary Public
State of
EXHIBIT A
AFFIDAVIT OF BILLS PAID
Vendor and/or Sub-ContractorName / Address / Telephone Number
(01/00)- 1 -M-19