Attachment H - CONTRACTORS AFFIDAVIT.pdf
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- Attached to
- Insulation at Fire Stations 3 and 4
- Solicitation number
- 24-015
- Issued by
- Macomb County, St. Louis City, Michigan
About this file
This document is a Contractor's Affidavit from Macomb Township, related to the Insulation project for Fire Stations 3 and 4. The affidavit is a standard form to be submitted as part of the final application for payment, specifically for a contract awarded under RFP 24-015 for insulation work at two fire station locations. The document serves as a comprehensive release and confirmation that all contractual obligations have been fulfilled, including full payment to subcontractors and resolution of all potential claims related to the project.
The affidavit provides a legally binding statement from the contractor waiving any future claims or liens against the project or the owner (Macomb Township) for labor and materials used in the project. It requires the contractor's authorized signature, printed name, title, and notarization, effectively serving as a final clearance document that confirms the successful completion of the insulation work and the contractor's financial settlements associated with the project. The form is designed to protect the township by ensuring all financial and contractual responsibilities have been met before final payment is processed.
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Text version
Macomb Township Attachment H
CONTRACTOR'S AFFIDAVIT
(To be submitted as part of Final Application for Payment)
The undersigned Contractor, _____________________________________________________________ hereby represents that on ________________________, The Contractor was awarded a Contract by, Macomb Township hereinafter called the Owner, for Insulation at Fire Station 3 & 4 in accordance with the terms and conditions of RFP 24-015; and the undersigned further represents that the subject Work has now been accomplished and the said Contract has now been completed.
The undersigned hereby warrants and certifies that all of (Contractor’s) indebtedness arising by reason of the said Contract has been fully paid or satisfactorily secured; and that all claims from Subcontractors and others for labor and material used in accomplishing the said Project, as well as all other claims arising from the performance of the said Contract, have been fully paid or satisfactorily settled. The undersigned further agrees that, if any such claim should hereafter arise, (Contractor) shall assume responsibility for the same immediately upon request to do so by the Owner.
The undersigned, for the Final Adjusted Contract Amount of $___________________ , which is hereby requested, does further hereby waive, release, and relinquish any and all claims or right of lien which the undersigned now has or may hereafter acquire upon the subject premises for labor and material used in accomplishing said Project, or upon the Owner, and its respective employees or agents.
This affidavit is freely and voluntarily given with the full knowledge of the facts, on this ______ day of
________________________ 20_____.
CONTRACTOR
By: ___________________________________ (Authorized Signature)
Name: _________________________________ (Print Name)
Title: __________________________________
Subscribed and sworn to before me, a Notary Public in and for _____________________ County,__________________ State on this _____ day of __________________________ , 20_________ .
____________________________________ My Commission Expires: ________________________ Notary Public
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