1-017 Certificate of Payment.pdf

CP 1

CERTIFICATE OF PAYMENT

(Do not sign this form until after the project’s construction Is complete.)

THE STATE OF TEXAS §

COUNTY OF MIDLAND §

__________________________Water Rehab Program 02______________________________

This document is to be signed by the undersigned (Contractor) only after all construction work for this project has been completed and accepted by the City of Midland, and after all suppliers and sub-contractors used by the undersigned for this project have been paid in full by the undersigned for any and all materials and work provided for the completion of this project. Any retainage for this project will be held by the City of

Midland until after the undersigned has signed this form.

The undersigned states that all debts, bills, and expenses that were incurred by the undersigned, his agents, or subcontractors employed by him, for labor, wages, materials and other purposes furnished for the above project have been paid and satisfied in full.

The undersigned, as general contractor for the above described project agrees to indemnify, hold harmless and defend the City, its officers, agents, and employees, from and against all claims and suits for damages, expenses, including court costs and attorney fees, arising out of or resulting from the undersigned contractor, his agents or subcontractors employed by him for expenses, warranties for items furnished, or labor performed and for any party that has supplied materials in connection with the repair or construction of the above referenced premises.

The undersigned contractor agrees to waive any and all claims it may have against the City, associated with, resulting from or arising out of the work performed at the above premises.

Further, the undersigned states that all labor performed by the undersigned, his agents, and subcontractors employed by him, has been completed in the usual and customary workmanlike manner and all

CP 2

work performed is accompanied with the usual and appropriate warranties for such work or repair, absent any disclaimer previously approved by the City of Midland.

I, the undersigned, release and relinquish unto the City of Midland, and their assigns the above described lien upon the above referenced property and hereby certify that all debts, bills, and expenses incurred by the undersigned, his agents, or subcontractors employed by him in connection with work done at the above premises have been fully paid, in exchange for payment in full to be made by the City of Midland for the performance on the above described premises.

WITNESS MY HAND on this _______ day of _______________________, 20______.

Signature

Typed or Printed Name

Title

Name of Company

SUBSCRIBED AND SWORN to before me on the _______ day of ________________________, 20______.

Notary Public, State of Texas

Typed or printed name

CP 3

My Commission expires:

Form Revised October 2025

CERTIFICATE OF PAYMENT