Contractor's Affidavit Form

CONTRACTOR'S AFFIDAVIT

Contractor Name:    Contractor Business Address:

Owner Name:    Owner Address:

Project Name:    Project Location:

Contract Date:    Original Contract Amount: $

Recitals

WHEREAS, Contractor is duly engaged in performing work, labor and furnishing materials under the Contract described above for the Project; and

WHEREAS, Owner has requested an affidavit from Contractor certifying payment status of subcontractors, suppliers, laborers and tax and payroll obligations related to the Project; and

WHEREAS, Contractor is competent to make the statements herein, and does so under penalty of perjury to induce Owner to release funds and to establish the absence or extent of claims and liens for the Project.

NOW, THEREFORE, for and in consideration of the mutual covenants and other good and valuable consideration, Contractor hereby certifies and affirms as follows:

1. Definitions

In this Affidavit, the capitalized terms shall have the meanings set forth: "Contract" means the written agreement between Owner and Contractor for the Project; "Subcontractor" means any person or entity performing work or furnishing materials to Contractor; "Supplier" means any person or entity supplying materials to Contractor or its subcontractors.

2. Affidavit of Facts

Contractor hereby affirms under oath that the statements contained in this Affidavit are true and based on Contractor's personal knowledge or on records maintained in the ordinary course of business. Contractor certifies that it has performed the labor and furnished the materials described in the Contract to date in a workmanlike manner and in accordance with the Contract documents.

3. Payment and Lien Status

Contractor certifies that, except as set forth in this Affidavit, all sums owed to Subcontractors, Suppliers, laborers, and materialmen for work performed and materials furnished through the date of this Affidavit have been paid in full from funds received by Contractor on account of the Project.

List of Subcontractors and Suppliers paid or to be paid and any amounts remaining outstanding (if none, state "None"):

Contractor certifies by checking the box below that, to the best of its knowledge, no liens, stop notices, or claims for payment exist against the Project except as disclosed in the Known Claims or Exceptions field.

  There are no outstanding liens, stop notices, or claims for payment for work, labor or materials relating to the Project.

Known claims, exceptions or liens (if any):

4. Taxes, Payroll and Benefits

Contractor represents that all federal, state and local payroll taxes, contributions and withholdings attributable to wages paid to employees for work on the Project have been paid or accrued in accordance with law and that Contractor has complied with all applicable workers' compensation, unemployment insurance, and employee benefit contribution obligations relating to the Project through the date of this Affidavit.

5. Indemnity

Contractor agrees to indemnify, defend and hold Owner harmless from and against any and all claims, demands, suits, losses, costs, expenses (including reasonable attorneys' fees) and liabilities arising out of Contractor's failure to pay Subcontractors, Suppliers, laborers or for any tax or payroll obligation relating to the Project that result in claims against Owner or the Property.

6. Representations and Warranties

Contractor represents and warrants that it has authority to execute this Affidavit, and that the individual executing this Affidavit on behalf of Contractor is duly authorized to bind Contractor. Contractor further warrants that no assignment of rights under the Contract has been made that would impair the accuracy of the statements contained herein.

7. Remedies and Withholding

Owner may rely upon this Affidavit in determining whether to release retained funds or make further payments under the Contract. If any material misstatement or omission is discovered in this Affidavit, Contractor shall be liable for damages, including but not limited to the cost of defending any claims and for correction of defective work, and Owner may withhold sums necessary to satisfy any resulting claim.

8. Notices

9. Amendments; Waiver; Severability; Entire Agreement

This Affidavit may be amended only by a writing executed by both Contractor and Owner. No failure or delay by Owner in exercising any right will operate as a waiver. If any provision of this Affidavit is held invalid or unenforceable, the remaining provisions shall remain effective. This Affidavit constitutes the entire agreement of the parties with respect to the subject matter herein and supersedes all prior oral or written statements and agreements.

10. Governing Law

This Affidavit shall be governed by and construed in accordance with the laws of the state in which the Project is located, without regard to its conflicts of law principles.

11. Execution Under Penalty of Perjury

The undersigned Contractor certifies under penalty of perjury under the laws of the jurisdiction in which the Project is located that the foregoing is true and correct to the best of Contractor's knowledge and belief.

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