15-Doc 00 65 19.16 - CONTRACTORS RELEASE OF LIENS.pdf
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- Attached to
- Heritage Hills WWTP Discharge Interconnection, Contract No. 6715-11 State and local contract opportunity
- Solicitation number
- Not on record
- Issued by
- Bucks County, Pennsylvania
About this file
This is a Contractor's Release of Liens form document associated with Upper Makefield Township's 2026 Road Paving Program in Pennsylvania. The form serves as a legal instrument through which contractors acknowledge receipt of payment and release all claims against the owner for work performed under the contract. The document pertains to roadway improvements involving milling, base repair, leveling course, manhole rim adjustments, and wearing course applications across various roads within Upper Makefield Township, with specific roadways and quantities defined in the contract exhibits.
The release of liens is contingent upon receipt of final payment and requires notarization before a Notary Public. The contractor must declare that all compensation, including approved change orders, has been received in full satisfaction of all monies owed under the agreement dated in association with Contract #26-00060. The form includes spaces for the contractor to specify the final payment amount and includes signature lines for individual contractors, partners, or duly authorized corporate representatives, along with required oath documentation and the corporate seal where applicable.
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Text version
CONTRACTOR'S RELEASE OF LIENS
00 65 19.16-1
DOCUMENT 00 65 19.16
STATE OF______________________________:
COUNTY OF ____________________________:
Before me, the undersigned, a Notary Public in and for said County and State personally appeared
(Individual/Partner/Duly Authorized Representative of Corporate Contractor)
Who being duly sworn according to law deposes and says that
_______________________________________________________________this day has received from (Contractor, Name and Address)
Upper Makefield Township, 1076 Eagle Road, Newtown, PA 18940 (Owner, Name and Address) the sum of One Dollar and other valuable considerations in full satisfaction and payment of all sums of money owed and payable to ______________________________________________ arising out of the (Contractor) performance of the Work including all approved change orders under an Agreement dated associated with Contract #26-00060: 2026 ROAD PAVING
PROGRAM
between Upper Makefield Township (Owner) and .
(Contractor)
THEREFORE,
(Contractor)
(for myself, my heirs, executors and administrators) (for itself, its successors and assigns) release, quit-claim and forever discharge Upper Makefield Township its successors and assigns, (Owner) of and from all claims and demands arising from or in connection with the aforementioned Agreement.
This Release is contingent upon receipt of the final payment of $___________.
00 65 19.16-2
CONTRACTOR
Company:
(Corp. Seal) Signature:
(Individual, Partner or Duly Authorized Representative of Corporate Contractor)
Name and Title:
Sworn and subscribed before me this
_____day of ________________,20___.
END OF DOCUMENT
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