Attachment_Q_-_Release_of_Lien_Forms.pdf
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- Solicitation number
- DCAM-26-CS-RFP-0005
- Issued by
- District of Columbia
About this file
This is a Release of Lien Forms document issued by the District of Columbia Department of General Services for the Anacostia Recreation Center Pool Replacement project. The document provides two standardized lien release forms—a partial Release of Liens and a Final Release of Liens and Claims—to be executed by consultants and contractors upon receipt of payments. Both forms require contractors to indemnify and release the District from all claims, liens, and stop work notices related to the project, while representing that all subcontractors, material suppliers, and workers have been properly compensated for labor, materials, equipment, services, taxes, insurance, and bonds. The forms must be signed by authorized representatives of the contractor and notarized by a District of Columbia Notary Public, with designated fields for project name, contract number, task order number, work performed description, contract date, contract amount, and payment amounts received.
The partial Release of Liens form is submitted upon receipt of interim payments and represents a percentage of the current contract value, while the Final Release of Liens and Claims form is executed upon receipt of the final payment and serves as the contractor's express consent to allow the District to make final disbursement. Both forms require the contractor to certify that all work has been performed in accordance with contract documents in a workmanlike manner and that all materials supplied to or incorporated into the project have been fully paid or sourced from open stock. The notarial section requires certification of the signer's identity and authority, with space provided for the notary's signature, seal, and commission expiration date.
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Text version
GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF GENERAL SERVICES
2000 14TH STREET, NW, 4TH FLOOR, WASHINGTON, D.C. 20009
FAX: (202) 671-0648
RELEASE OF LIEN
Project Name:
Contract No.:
Task Order No.:
Work Performed:
Contract Date:
Contract Amount:
Date:
Release of Liens:
The undersigned (insert Consultant/Contractor), has been paid partial payments totaling the sum of (insert net amounts), which is _____% of the current contract value, in accordance with the contract terms for the above referenced project, and hereby indemnifies, waives, releases and holds the District of Columbia harmless for the above referenced project, including all claims, right to liens, and stop work notices upon said premises or the improvements thereon under the statutes of the jurisdiction in which the project is located.
In consideration of this payment due in the net amount of insert net amount due, in accordance with contract terms for the above referenced project. Hereby indemnifies, waives, and releases the District of Columbia for the above referenced project. All claims, right to liens, stop work notices upon said premises or the improvements thereon under the statues of the jurisdiction in which the project is located.
The undersigned further represents and warrants, as of this date, that he/she is duly authorized to sign and execute this Release of Liens on behalf of (insert Consultant/Contractor); that (insert Consultant/ Contractor) has properly performed all work in accordance with the Contract Documents and that all consultants, subcontractors or material men have been paid for all labor, including fringe benefits, workers compensation, materials, equipment, services, taxes, insurance premiums, and bonds (if required), and that any materials supplied to or incorporated in this project were taken from fully paid or open stock with any exceptions noted below.
This letter must be signed and notarized below by authorized individuals.
Insert Consultants /Contractors name: _______________
By:___________________
Print Name: ___________________
Title: ________________ Date: _______________
DISTRICT OF COLUMBIA ) ss
I, a Notary Public in and for the District of Columbia, hereby certify that, on this ___ day of , 20 , personally appeared before me , known to me (or satisfactorily proven) to be the person who executed the foregoing Final Release of Liens and Claims, as of (insert Consultant/Contactor name) who acknowledged having done so for the purposes therein contained.
IN WITNESS WHEREOF, I have set my hand and official seal.
Notary Public, D.C.
My commission expires: _______________________________
[NOTARIAL SEAL]
GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF GENERAL SERVICES
2000 14TH STREET, NW, 5TH FLOOR, WASHINGTON, D.C. 20009
FAX: (202) 671-0648
FINAL RELEASE OF LIENS AND CLAIMS
Project Name:
Contract No.:
Task Order No.:
Work Performed:
Contract Date:
Contract Amount:
Date:
Final Release of Liens and Claims:
The undersigned (insert Consultant/Contactor name), in consideration of payments received and upon receipt of the amount of a final payment of $ __________________ hereby indemnifies, waives, releases, and holds the District of Columbia harmless for the above referenced project, including all claims, right to liens, terminations, and stop notices upon said premises or the improvements thereon under the statutes of the jurisdiction in which the project is located.
The undersigned further represents and warrants, as of this date, that he/she is duly authorized to sign and execute this Release of Final Liens and Claims on behalf of (insert Consultant /Contractor; that (insert Consultant /Contractor) has properly performed all work and furnished all materials of the specified quality in accordance with all contract documents in an acceptable workmanlike manner to the Department of General Services/Construction Division, District of Columbia and that (insert Consultant /Contractor) has paid for all labor, including fringe benefits and workers compensation, all materials, equipment, services, taxes, insurance premiums, and bonds (if required) and that any materials supplied to or incorporated in this project have been paid.
(Insert Consultant/Contactor) is executing this Final Release of Liens and Claims for the express purpose of inducing the District to make final disbursement and payment to (insert Consultant/Contactor name) of
This letter must be signed and notarized below by authorized individuals.
Insert Consultants /Contractors name: _______________
By:___________________
Print Name: ___________________
Title: ________________ Date: _______________
DISTRICT OF COLUMBIA ) ss
I, a Notary Public in and for the District of Columbia, hereby certify that, on this ___ day of , 20 , personally appeared before me , known to me (or satisfactorily proven) to be the person who executed the foregoing Final Release of Liens and Claims, as of (insert Consultant/Contactor name) who acknowledged having done so for the purposes therein contained.
IN WITNESS WHEREOF, I have set my hand and official seal.
Notary Public, D.C.
My commission expires: _______________________________
[NOTARIAL SEAL]
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