Subcontractor Partial Waiver Of Lien And Release Forms

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SUBCONTRACTOR PARTIAL WAIVER OF LIEN AND RELEASE FORM
State of ___________ )
) ss:
County of _________ )
The undersigned, being of lawful age, under oath does hereby swear that the following
statements are true:
1.
I am the ____________ of ______________ (“Subcontractor”), and have personal
knowledge of the truthfulness of all statements made herein. I am duly authorized to make such
statements on behalf of the Subcontractor and to execute and deliver this Partial Waiver and
Release by and on its behalf.
2.
Pursuant to an Agreement dated _______, 2015 between the undersigned and
[name of General Contractor] (“Contractor”), Subcontractor acknowledges that it has provided
services, labor and/or materials in connection with the [office/retail] project owned by [name of
tenant] (“Owner”), located at _________________, in Boston, MA (the “Project”).
Subcontractor hereby acknowledges receipt of payments in connection with the Project up to and
including Requisition/Invoice No. ___ in the sum of $_________.
3.
In consideration of the payments hereby received by Subcontractor, Subcontractor
hereby waives and releases its rights to file any mechanic’s, materialmen’s or similar liens and
demands against Owner, Brookfield Properties 75 State Co. LLC (“Landlord”), the Project
and/or the premises where the Project is located, on account of labor and services performed,
and/or materials provided to the Contractor, Owner or the Project, and expenses accrued in
connection with the Project up to and including Requisition/Invoice No. _____.
Signed under the penalties of perjury this _____ day of ________, 2015.
[_________________], Subcontractor
By:
Title:
SWORN TO AND SUBSCRIBED before me by ____________________ on this ____ day of
___________, 2015.
Notary Public, Commonwealth of Massachusetts
My Commission Expires: ____________________

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