32-Doc 00 65 19.16 ContractorsRelease.pdf

Borough of Doylestown 00 65 19.16 Contractor Release of Liens 2400754 - Fanny Chapman - Main Pool Repairs Page 1 of 1

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 (Contractor Name) this day has received from (Contractor Address)

Borough of Doylestown, 10 Doyle Street, Doylestown, PA 18901 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 performance of the Work including all approved change orders under an Agreement dated associated with

Contract 2400754: Borough of Doylestown - Fanny Chapman Memorial Pool - Main Pool Repairs between Borough of Doylestown, 10 Doyle Street, Doylestown, PA 18901 (Owner) and

(Contractor).

THEREFORE, (Contractor) (for myself, my heirs, executors and administrators) (for itself, its successors and assigns) release, quit-claim and forever discharge

Borough of Doylestown (Owner) its successors and assigns, 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 $ .

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___

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