39-Doc 00 65 19.13 - CONTRACTORS AFFIDAVIT.pdf
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- Attached to
- 1121 Horsham Road Demolition (26-01054)
- Solicitation number
- US.258594
- Issued by
- Pennsylvania
About this file
This is a Contractor's Affidavit form associated with Contract 2026-01054 for the 1121 Horsham Road Demolition project between Horsham Township, located at 1025 Horsham Road, Horsham, Pennsylvania 19044, and the contractor performing the work. The affidavit serves as a sworn statement certifying that upon completion of the demolition project, all labor, materials, and outstanding claims or indebtedness arising from the performance of work, including all approved change orders, have been satisfied and paid in full. The form requires notarization and must be executed by an individual, partner, or duly authorized representative of the contracting entity.
The project involves demolition of an existing residential home with associated site work including abandonment of water service and sanitary service at the mains, grading of disturbed areas to match surrounding topography, and permanent stabilization of the site. This affidavit is a standard contractual document required to be submitted upon project completion to verify that all financial obligations have been discharged and that no outstanding liens or claims remain against the contractor or property owner.
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Text version
CONTRACTOR'S AFFIDAVIT
00 65 19.13-1
DOCUMENT 00 65 19.13
CONTRACTOR'S AFFIDAVIT
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 all labor, material and outstanding claims and indebtedness of whatever nature arising out of the performance of the Work including all approved change orders under an Agreement dated _______________________, 20___ associated with
Contract 2026-01054: 1121 Horsham Road Demolition
Between Horsham Township, 1025 Horsham Road, Horsham, PA 19044 (Owner, Name and Address) and________________________________________________________________________________
(Contractor, Name and Address) have been satisfied and paid in full.
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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