7-Doc 00 65 19.16 - CONTRACTORS RELEASE OF LIENS.pdf
PDF 130 KB Posted
- Attached to
- 1121 Horsham Road Demolition (26-01054)
- Solicitation number
- US.258594
- Issued by
- Pennsylvania
About this file
This is a Contractor's Release of Liens form associated with Contract 2026-01054 for the 1121 Horsham Road Demolition project in Horsham Township, Pennsylvania. The form serves as a legal document whereby a contractor certifies receipt of final payment and releases all claims and liens against Horsham Township, located at 1025 Horsham Road, Horsham, PA 19044, related to work performed under a specified agreement including all approved change orders. The release is contingent upon receipt of the final payment amount, with the contractor receiving One Dollar and other valuable considerations in exchange for the release. The document requires notarization and signatures from the contractor or a duly authorized representative, and must include the agreement date and the final payment amount to be completed.
The form is a standard template containing blank fields for completion with specific project details, financial terms, and signatures. No pricing information, set-asides, incumbents, funding sources, or other financial terms are specified within this document itself, as it is designed as a contingent release instrument to be executed upon conclusion of contract performance. The document's execution is limited to satisfying lien release requirements and does not establish independent contract terms or conditions.
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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
Contract 2026-01054 – 1121 Horsham Road Demolition between Horsham Township, 1025 Horsham Road, Horsham, PA 19044 (Owner) and ________________________________________________________________________________.
(Contractor)
THEREFORE, ________________________________________________________________________ (Contractor) (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___.
File details come from the government source that posted it. Updated .