Vendor Lien Waiver And Release - All States printable pdf download

VENDOR LIEN WAIVER AND RELEASE – ALL STATES (PARTIAL)

VENDOR:

CONTRACTOR: DN DESIMONE CONTRUCTION CO INC

OWNER:

PROJECT:

CHECK #:

CHECK DATE:

INVOICE NUMBER

INVOICE DATE

DESCRIPTION

AMOUNT

For a valuable consideration (in the amount of $

), the receipt of which is hereby acknowledged:

1.Effective upon receipt from CONTRACTOR of the amount stated to be due in said Partial Request for Payment or such lesser amount

as CONTRACTOR may acknowledge to be due in accordance with the provision of the CONTRACT, VENDOR does now hereby

absolutely waive all liens and rights or claims of lien against the PROPERTY which VENDOR ever had, has or may have, and does

release the CONTRACTOR and OWNER from any claim, liability or debt by reason of labor, services, equipment, materials and rentals

which have been or will be performed or furnished by VENDOR to or for the Project under the CONTRACT, including without

limitation, all “claims”, “changes”, “extras” and other charges of any description.

2.VENDOR further represents and certifies that no lien has been filed against the PROPERTY by VENDOR or any laborer, sub-

subcontractor or material-man who has directly or indirectly furnished labor, services, equipment, rentals or materials to or for the

PROJECT under the CONTRACT and the VENDOR has paid all bills, taxes (including applicable Sales and Use Taxes) and charges at

the agreed prices for all of said labor, services, equipment, rentals and materials which have been or are to be furnished to or for the

PROJECT under the CONTRACT.

IN WITNESS WHEREOF, VENDOR has either individually or by its duly authorized representative set his hand and seal hereto this

________day of ____________________, 20_____.

Name of VENDOR: _____________________________________________________ Title: _______________________________________

(Owner, Partner, Officer) (Please Designate)

By:________________________________________________

(Signature)

(Corporate Seal)

Sworn to (or affirmed) and subscribed before me on this ___________________ day of ____________________, 20____, by

__________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) who

appeared before me.

______________________________________________________

(Notary Seal)

Signature of Notary Public

_____________________________________________________________

Printed Name of Notary Public

Commission Expires: _________________________State: ___________

Vendor Lien Waiver And Release - All States