6-DOC 00 65 19.16 CONTRACTORS RELEASE OF LIENS.pdf
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- Solicitation number
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- Issued by
- Montgomery County, Pennsylvania
About this file
This is a Contractor's Release of Liens form used by Montgomery Township, Pennsylvania, located at 1001 Stump Road, Montgomeryville, PA 18936-9605. The form is executed by a contractor upon receipt of final payment for work performed under a contract agreement for the supply and installation of a front power take-off (PTO), front 3-point hitch, and an 11-foot or 12-foot hydraulic angle snowplow for a John Deere 6120M tractor. The release document serves as a sworn statement before a notary public in which the contractor acknowledges receipt of payment in full satisfaction of all sums owed, including all approved change orders, and releases the owner and its successors and assigns from all claims and demands arising from or in connection with the agreement. The release is contingent upon receipt of the final payment amount specified in the document and must be executed by an authorized representative of the contracting entity, whether an individual, partner, or corporate representative.
The form requires notarization and includes space for the contractor's company seal, signature, name, title, and the date of execution. This document is a standard contractual requirement for Pennsylvania public works projects and serves to protect the owner from future lien claims by the contractor upon completion of work and full payment. The document does not contain pricing information, performance requirements, or other project-specific details beyond identifying the scope of work and the contracting parties involved.
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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)
(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
Supply and Installation of Front PTO, Front 3-Point Hitch, and 11-Foot or 12-Foot Plow for John Deere 6120M Tractor between Montgomery Township, 1001 Stump Road, Montgomeryville, PA 18936-9605
(Owner) and .
THEREFORE,
(for myself, my heirs, executors and administrators) (for itself, its successors and assigns) release, quit-claim and forever discharge (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 $ .
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 .
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