Partial_Release_of_Lien_Subcontractors_and_Suppliers.pdf
PDF 63 KB Posted
- Attached to
- Rob Sullivan Park Maintenance Barn State and local contract opportunity
- Solicitation number
- 05-15
- Issued by
- Volusia County, Florida
About this file
This is a Partial Release of Lien Form for subcontractors and suppliers related to the City of Debary's Rob Sullivan Park Maintenance Barn project (Bid # 05-15) in Florida. The form serves as a partial waiver of lien rights by subcontractors and suppliers, applicable only to the extent of payments received for labor, services, materials, or work completed up to a specified date. The document establishes that the undersigned party releases all lien claims against the real property and improvements associated with the project, specifically a 25' x 40' x 14' A-frame steel building that includes delivery and installation. The form clarifies that this partial release applies only to work and materials furnished prior to the date of the previous application for payment, and explicitly excludes any charges for changes, additions, or extras.
The form requires the subcontractor or supplier to warrant that all laborers employed and all material bills have been fully paid to the extent of the payment referenced in the waiver. The document must be executed under seal and notarized, with the authorized representative signature, printed name, and title required. The form includes acknowledgment provisions whereby a notary public verifies the identity of the signing party and confirms whether an oath was administered. This document is a standard protective mechanism for the City of Debary, ensuring that payments made to subcontractors and suppliers do not create conflicting lien claims against the project property.
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Text version
City of Debary – Rob Sullivan Park Maintenance Barn (Bid # 05-15)
SECTION 00646
PARTIAL RELEASE OF LIEN FORM (SUBCONTRACTOR / SUPPLIER)
KNOW ALL MEN BY THESE PRESENTS, that the undersigned, 1) , in consideration of the sum of 2) , and other valuable considerations and benefits to the undersigned accruing, do hereby waive, release and quit claim all liens, lien rights, claims or demands of every kind whatsoever which the undersigned now has, or may hereafter have, against that certain real estate and the improvements thereof, situated in County, State of , and described as 3) , on account of work and labor performed, and/or materials furnished in, to, or about the construction of any building or buildings situated thereon, or in improving said property above described, or any part thereof.
1) Subcontractor / Supplier
2) Amount of Work Completed through Previous Application for Payment
3) Name of Project identified in Instructions to Bidders
It being the understanding of the undersigned that this is a Partial Waiver and Release of Lien which the undersigned has against the premises described herein, only to the extent of the payments specified and only for labor, services, or materials furnished or work done up until 4) , (but not releasing or waiving charges for changes, additions, or extras), the undersigned warrants that no assignment of said liens or claims, nor the right to perfect a lien against said real estate, by virtue of the accrual of said payment, has or will be made, and that the undersigned has the right to execute this Partial Waiver and Release, and that all laborers employed by the undersigned, and all bills for materials and supplies furnished by others to the undersigned in connection with the construction of improvements upon the aforesaid premises, to the extent of the payment herein referred to, have been fully paid.
4) Date of Previous Application for Payment
IN WITNESS WHEREOF, I/we have executed this instrument under seal this day of
Authorized Representative (Signature)
(SEAL)
Printed Name and Title
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this day of , by of (corporation), on behalf of the corporation, who is
City of Debary – Rob Sullivan Park Maintenance Barn (Bid # 05-15) personally known to me or has produced (Type of Identification) as identification and who did (did not) take an oath.
Sworn to and subscribed to before me this day of , (Signature)
(Print name) Notary Public in and for the County and State Aforementioned
My Commission Expires:
END OF SECTION
File details come from the government source that posted it. Updated .