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Contractor's Verified Statement

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CONTRACTOR'S AFFIDAVIT - INDIVIDUAL

STATE OF ILLINOIS

COUNTY OF

The undersigned, upon being duly sworn, states that he/she is the contractor for the

work on the building located at

owned by

That the total amount of the contract including extras is $ on which he/she has received payment of $ prior to this payment.

That the following are the names of all parties who have furnished material or labor, or both, for said work, and the amount due or to become due to each.

Name Address Labor/Material Supplied Contract Amount Amount Paid Amount Payment Due Balance

Signed this day of , 20

Contractor

Type or Print Name

State of

County of

Signed and sworn (or affirmed) to before me on by (name/s of person/s making statement).

Signature of Notary Public

(SEAL)

(770 ILCS 60/5)

It shall be the duty of the contractor to give the owner, and the duty of the owner to require of the contractor, before the owner or his agent, architect, or superintendent shall pay or cause to be paid to the contractor or to his order any moneys or other consideration due or to become due to the contractor, or make or cause to be made to the contractor any advancement of any moneys or any other consideration, a statement in writing, under oath or verified by affidavit, of the names and addresses of all parties furnishing materials and labor and of the amounts due or to become due to each. Merchants and dealers in materials only shall not be required to make statements.

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What a Contractor's Verified Statement Is

A Contractor's Verified Statement is a formal, signed declaration provided by a contractor that verifies specific facts about a construction project or contracted services. Typical uses include confirming contract amounts, subcontractor participation, payroll or prevailing wage compliance, lien waivers, and certification of completion milestones. The statement functions as an affidavit-like record for owners, general contractors, public agencies, and lenders. It can be executed on paper or electronically where permitted, and when properly completed it becomes part of the project record used for payment, compliance audits, and public filings.

Why a Clear Verified Statement Matters

Provides formal, verifiable evidence of contractor assertions to support payment, lien release, regulatory compliance, and dispute resolution. A clear Verified Statement reduces administrative delays, documents chain-of-custody for subcontractor payments, and supplies a concise record for auditors and contracting authorities.

Why a Clear Verified Statement Matters

Who typically prepares and relies on this statement

Owners, general contractors, public agencies, and lenders commonly require a Contractor's Verified Statement during project closeout and payment reviews.

  • General contractors use it to confirm subcontractor invoices, project payments, and retention releases.
  • Owners request it to verify compliance with contract terms, prevailing wage rules, and completion status.
  • Public agencies accept it with permit closeouts, funding draws, and public works audits.

The document streamlines verification workflows and reduces disputes by creating a single, signed record per reporting period.

Core components to include in a professional statement

Essential sections and presentation elements to include in a professional Contractor's Verified Statement to ensure legal clarity and processing efficiency across project stakeholders.

Header

Include project name, contractor legal name, contract number, owner, and date. A clear header ties the statement to the underlying contract and aids indexing in project records for audit and payment reconciliation.

Contract Details

List original contract value, change orders executed, current contract balance, and purchase order numbers. Provide concise references so reviewers can match statement entries to invoices, purchase orders, and payment requisitions.

Scope & Schedule

Describe work performed during the reporting period, completion percent, and any outstanding punch-list items or delays. Tie schedule notes to specific dates and milestones for enforceable reference.

Payment Summary

Summarize amounts billed, withheld, retained, and previously paid. Include line items for subcontractor payments and pending claims to clarify outstanding obligations before release.

Compliance Certifications

Declare compliance with prevailing wage laws, permit conditions, bonding requirements, or minority business participation where applicable. Cite the specific contract clause or statutory obligation addressed.

Signature Block

Provide printed name, title, company, execution date, and physical or electronic signature method. Note whether notarization, witness, or corporate resolution is attached if required.

Step-by-step: preparing and submitting the statement

Stepwise process to prepare, verify, and submit a Contractor's Verified Statement for payment and compliance review.

  • 01
    Gather Documents: Collect contracts, change orders, and payment records.
  • 02
    Draft Statement: Populate fields with contract-specific data and totals.
  • 03
    Review & Certify: Internal review, legal check, and authorized signer approval.
  • 04
    Submit: Deliver to owner, lender, or agency per contract instructions.

Suggested online workflow settings for digital completion

Recommended online workflow settings and field configurations for digital completion, routing, and recordkeeping of the Contractor's Verified Statement.

Field Configuration
Signature Field Required; allow typed or digital certificate.
Date Field Auto-fill MM/DD/YYYY when signer completes.
Authentication Email plus SMS code or KBA for sensitive projects.
Routing Order Sequential routing: contractor then owner then lender.

Document flow from preparation to archive

How the Verified Statement moves from the contractor through authorized reviewers to final record.

  • Prepare: Complete the statement and attach supporting invoices.
  • Authenticate: Signer confirms identity and signs electronically or notarized.
  • Route: Send to owner, lender, and compliance officer for review.
  • Archive: Store executed statement and audit trail in procurement records.

Digital signing and platform considerations

Digital submission and e-signature considerations for secure, auditable execution.

  • File Formats: PDF or DOCX preferred for compatibility.
  • Integrations: Connect to accounting and project systems.
  • Authentication Options: Email, SMS, or certificate-based checks.

Ensure chosen platform supports audit trail, encryption, and any required notarization.

Typical deadlines and timing to watch

Key timing rules and common deadlines tied to contractor Verified Statements, payment requisitions, and retainage release schedules.

Payment Requisition Cutoff:

Follow contract-specified monthly or milestone deadlines for invoice inclusion.

Owner Review Period:

Typical 7–30 day review windows; check contract for exact term.

Lien Filing Window:

State lien notice deadlines vary; act quickly after unpaid claims.

Notarization / Witness Timing:

Obtain notarization before filing or if required by contract.

Record Retention Start:

Retention begins on execution date or final payment date.

Common preparation mistakes to avoid

  • Incomplete supporting documents — missing change orders, subcontractor waivers, or invoices frequently delay payment and trigger additional documentation requests from owners or auditors.
  • Mismatched names or tax IDs — using DBAs instead of legal entity names can cause backup withholding or slow verification with payroll and tax departments.
  • Incorrect amounts or math errors — rounding mistakes, misallocated change orders, or inconsistent totals lead to payment holds and manual reconciliation.
  • Skipping required notarization or witness steps — omitting state or contract-required authentication can render the statement unacceptable for filing or funds release.

Consequences of incorrect or incomplete statements

Payment Delay: Hold or denied payment.
Lien Exposure: Subcontractor liens possible.
Tax Withholding: Backup withholding risk.
Contract Breach: Claims for noncompliance.
Audit Findings: Regulatory fines possible.
Legal Liability: False statement penalties.

Typical eSignature vendor comparison for executing contractor statements

Comparison of common eSignature feature criteria and starting prices. signNow is listed first per vendor ordering requirements.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Essential data elements to capture on the form

Contractor Name: Legal entity name
Contract Number: Identifier for matching records
Project Address: Jobsite street address
Monetary Totals: Gross, paid, retained
Compliance Checks: Prevailing wage, bonding
Signatory Info: Name, title, date

Who is authorized to sign a verified statement

Authorized Officer

An officer or company representative with corporate authority should sign when the contractor is a corporation. The signer must be empowered by corporate resolution or company bylaws to bind the entity and accept financial and legal obligations on its behalf.

Authorized Agent

A designated project manager or authorized agent may sign if documentation (power of attorney or written delegation) demonstrates their authority. The owner or payer may require proof of authorization before accepting the statement as binding.

Practical tips for accurate and efficient completion

Recommendations to reduce review cycles, prevent payment delays, and create an auditable record.

Verify legal names and tax IDs
Confirm the contractor's exact legal name and tax identification before submitting. Mismatches with IRS or payer records commonly trigger backup withholding, rejected payments, and time-consuming corrections.
Reconcile invoices and change orders first
Ensure billed amounts match supporting invoices and approved change orders. Reconciling totals beforehand minimizes disputes with owners and reduces manual adjustments during payment processing.
Use explicit contract references
Reference the precise contract clause, change order number, or invoice numbers that support each line item. Clear cross-references speed review and reduce questions from auditors or payment administrators.
Keep organized supporting documentation
Attach or index certified payrolls, lien waivers, and subcontractor affidavits. Maintain a single searchable folder for each reporting period to simplify audits and claims responses.

Frequently asked questions and answers

Answers to frequent questions contractors and administrators raise when preparing, signing, or submitting a Contractor's Verified Statement for payment or filing.


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