Attachment G - PARTIAL WAIVER OF LIEN.pdf

Macomb Township Attachment G

PARTIAL WAIVER OF LIEN

(To be submitted by the Contractor for all Sub-Contractors and Suppliers with the Contractor's periodic

Request for Progress Payment)

To All Whom It May Concern:

WHEREAS, the undersigned has been engaged by (A) Macomb Township to furnish labor and materials for (B)____________________________________________________________________________ work, under a contract (C)_______________________________________________________________ for the improvement at the project described as (D) __________________________________________

__________in the Township (City, Township, Village) of Macomb , County of Macomb, State of

Michigan, of which Macomb Township is the Owner.

NOW, THEREFORE, this ______ day of _______________________________, 20_____ , for and in consideration of the sum of (E) __________________________________ Dollars paid simultaneously herewith, the receipt whereof is hereby acknowledged by the undersigned, the undersigned does hereby waive and release to the extent only of the aforesaid amount, any lien rights to, or claim of lien with respect to and on said above-described project, and the improvements thereon, and on the monies or other considerations due or to become due from the owner, by virtue of said contract, on account of labor, services, materials, fixtures, apparatus or machinery furnished by the undersigned to or for the above-described project, but only to the extent of the payment aforesaid.

(F)____________________________________________ (SEAL)

(Name of the sole ownership, corporation, or partnership)

(Affix corporate seal here) ______________________________________________(SEAL)

(Signature)

TITLE: ___________________________________________

INSTRUCTIONS FOR PARTIAL WAIVER

(A) Name person or firm with whom you agreed to furnish either labor, or services, or materials, or both.

(B) Fill in nature and extent of work; strike the word labor or the word materials if not in your contract.

(C) If you have more than one contract on the same premises, describe the contract by number if available, date and extent of work.

(D) Furnish an accurate enough description of the improvement, and location of the project so that it can be distinguished from any other Contract.

(E) Amount shown should be the amount actually received on that date.

(F) If waiver is for the corporation, corporate name should be used, corporate seal affixed and title of officer signing waiver should be set forth; if waiver is for a partnership, the partnership name should be used, partner should sign and designate himself as partner.