Fill and Sign the Business Entity Form

NOTICE OF DISPUTED WORK (Business Entity as Direct Contractor) Name of direct contractor:       Street Address:       City, State and Zip Code:       Name of owner:       Street Address:       City, State and Zip Code:       Name of construction lender:       Street Address:       City, State and Zip Code:       Site of the Improvement: Street Address:       City, State and Zip Code:       Legal Description:       COMES NOW,       , the direct contractor for the work of improvement at the above site location and provides notice of a bona fide dispute between the undersigned direct contractor and       , a subcontractor. The undersigned hereby provides notice that the undersigned will withhold from the subcontractor with whom the dispute exists its portion of the retention proceeds, not to exceed 150 percent of the estimated value of the disputed amount. Dated:       Name of Entity:       ATTESTED BY: (if required) A Corporation By: Signature Signature of authorized signatory             Type or Print Name Type or Print Name       Its:       Position or Rank Capacity of Signatory Notice of Disputed Work Page 1 of 3 CA Civil Code § 8814 PROOF OF NOTICE DECLARATION (Civil Code § 8118) I,       , declare that I have served copies of the NOTICE OF DISPUTED WORK by (check appropriate box below): a. By personally delivering copies to: Name:       Title:       At: (Street Address)       City, State and Zip Code:       On:       , 20       , at       am / pm. [Provide the above information for all other parties personally served on attached Exhibit A] b. By Certified, Express, or Registered Mail Service, postage prepaid addressed to: Name:       Title:       At: Street Address:       City, State and Zip Code:       On:       , 20       [Provide the above information for all other parties served by mail / express service on attached Exhibit A] See attached documentation provided by the US Postal Service or express mail service showing the date of delivery and the name of the person accepting delivery; tracking record or other documentation from express carrier showing attempted delivery or delivery of the notice; or, in the event of non-delivery, the returned envelope itself. I declare under penalty of perjury that the foregoing is true and correct. Signed at       , California , on       , 20 ______ . Signature       Print or Type Name A notary public or other officer completing the certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ______________________ Notice of Disputed Work Page 2 of 3 CA Civil Code § 8814 On ______________________ before me, ______________________ (here insert name and title of the officer), personally appeared ______________________ , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. _____________________________________________ Signature (Seal) Notice of Disputed Work Page 3 of 3 CA Civil Code § 8814