Attachment J - FINAL UNCONDITIONAL WAIVER OF LIEN.pdf
PDF 92 KB Posted
- 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 Final Unconditional Waiver of Lien form issued by Macomb Township in Michigan, intended to be submitted by contractors and subcontractors with their final application for progress payment. The form is specifically related to a project involving expanding foam insulation at Fire Stations 3 and 4 located in Macomb, with addresses at 47711 North Avenue and 16820 25 Mile Road, respectively. The waiver serves to release any lien rights or claims associated with labor, materials, services, fixtures, apparatus, or machinery furnished for the project.
The waiver document provides a standardized template for contractors to acknowledge receipt of payment and formally relinquish any potential future lien claims against the project or the owner (Macomb Township). While the specific payment amount is left blank to be filled in, the form indicates that the waiver is contingent upon simultaneous payment. The document includes detailed instructions for completion, specifying how to fill out various sections such as naming the contracting entity, describing the work performed, and providing appropriate signatures and seals for different business structures (corporations, partnerships, sole proprietorships).
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Text version
Macomb Township Attachment J
FINAL UNCONDITIONAL WAIVER OF LIEN
(To be submitted by the Contractor for all Sub-Contractors and Suppliers with the Contractor's Final
Application 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 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 on account of labor, services, materials, fixtures, apparatus or machinery heretofore be furnished by the undersigned to or for the above-described project by virtue of said contract.
(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.
File details come from the government source that posted it. Updated .