Builder's Certification Form

BUILDER'S CERTIFICATION FORM

This Builder's Certification Form is executed by the builder or general contractor to certify compliance with the contract documents, applicable codes, permits, inspections, and payment obligations related to the construction work described below. The builder attests under penalty of perjury that the statements and supporting information provided on this form are true and complete.

1. Builder / Contractor Information

2. Owner / Developer Information

3. Property Identification

4. Construction & Contract Financials

Contract Price: $   Deposit / Progress Payments Received: $

5. Permits, Inspections, Certificate of Occupancy

Building permit obtained:   Permit number:   Permit issue date:

Final building inspection passed:   Electrical passed:   Plumbing passed:

Certificate of Occupancy (CO) issued:   CO number:   CO issue date:

6. Certifications & Attestations (Builder)

By signing below the builder certifies the following statements are true and accurate as of the date of signature:

1. Work completed conforms to the approved construction documents, applicable building codes and ordinances, and any conditions of permits issued by the authority having jurisdiction.
2. All required inspections have been requested and completed, unless noted in the exceptions section below.
3. All subcontractors, suppliers and materialmen have been paid in full for work performed through the date of this certification, except as disclosed in the exceptions section.
4. No liens, stop notices or claims are outstanding against the property except as disclosed below.
5. As‑built drawings, warranties, and operating manuals for installed systems have been delivered to the owner or will be delivered upon final closeout as indicated below.

As‑built plans delivered:   Operation manuals delivered:

7. Warranties

Builder provides the following standard warranties unless otherwise stated in the construction contract:

8. Liens, Payments & Lien Waivers

Builder certifies that all subcontractors, suppliers and laborers have been paid for work performed through the date of this certification, except as described in the exceptions section above. Builder agrees to deliver unconditional lien waivers for payments received as required by the contract within the timeframe specified in the contract.

Conditional lien waivers attached:   Unconditional lien waivers attached:

9. Change Orders / Outstanding Work

10. Disclosures

Lead‑based paint or hazards known to builder:   Mold or water intrusion previously repaired:   Asbestos or hazardous material known:

11. Defaults, Indemnity, Governing Law

Default by the builder under the construction contract entitles the owner to pursue all remedies available at law and in equity, including but not limited to completion of the work by others and recovery of costs. The builder shall indemnify, defend and hold the owner harmless from claims, losses, damages and expenses resulting from the builder's negligence in performance of the work, subject to the terms and limitations of the construction contract.

Governing law: The parties agree that the interpretation and enforcement of this certification shall be governed by the laws of the state of .

Entire agreement: This Certification, together with the construction contract and incorporated documents, constitutes the entire agreement regarding the matters certified herein and supersedes any prior certifications or oral representations by the builder with respect to such matters.

12. Acknowledgment

The undersigned builder declares under penalty of perjury under the laws of the governing jurisdiction that the foregoing is true and correct.

Sign Now