HomeMy Public PortalAboutLiens Affidavit EECBG.pdfNew Form – April 12, 2011
FINAL CONTRACTOR WAIVER OF LIEN AND RELEASE
TO: Georgia Environmental Finance Authority
233 Peachtree Street
Harris Tower, Suite 900
Atlanta, Georgia 30303
RE: Subrecipient: ______________________ ______________________________________________
Contract: __________________________________________________________________________
Contractor(s): ____________________________________________________________________________________
Project Location(s): ________________________________________________________________________________
1. The undersigned Contractor hereby certifies that it performed all of its work at the above specified Project Location(s) in
accordance with the terms of the above specified Energy Efficiency and Conservation Block Grant Contract (EECBG), including the
Contract Scope of Work attached as Exhibit A thereto; and all applicable laws, ordinances, policies and codes of the Federal, State
and local governments.
2. The Contractor further certifies that all of the work, equipment, supplies, materials, labor and services furnished by the
Contractor and its suppliers, materialmen, Contractors, and laborers at the above specified Project Location(s), in accordance with
above specified EECBG Contract, have been fully paid for and the Contractor and its suppliers, materialmen, Contractors, and
laborers have been paid and satisfied in full, and that there are no outstanding claims of any character (including disputed claims or
any claims to which the Contractor has or will assert any defense) arising out of the performance of the contract which have not
been paid and satisfied in full except as listed hereinbelow:
[Instructions- ENTER THE WORD “NONE” OR LIST THE NAMES OF CLAIMANTS
AND THE AMOUNT CLAIMED BY EACH]
3. The Contractor further certifies that the above specified Project Location(s) cannot be made subject to any valid lien or
claim (including disputed claims or any claims to which the Contractor has asserted or will assert any defense) by anyone who
furnished work, equipment, supplies, material, labor or services to the Contractor at the Project Location(s) and/or in accordance
with the terms of the above specified EECBG Contract.
4. The Contractor hereby releases GEFA, the Energy Efficiency and Conservation Block Grant program, and the owner(s)
of the above specified Project Location(s) from all liability in connection with the work, equipment, supplies, materials, labor and
services furnished by the Contractor and its suppliers, materialmen, Contractors, and laborers at the Project Location(s) and/or in
accordance with the above specified EECBG Contract.
5. The Contractor has received final payment in full satisfaction and settlement of all claims against the Energy Efficiency
and Conservation Block Grant program and GEFA arising by virtue of its work at the above specified Project Location(s) and/or in
accordance with the terms of the above specified EECBG Contract, and acceptance of such payment is acknowledged as a release
of EECBG and GEFA from any and all claims arising under or by virtue of the subcontract.
6. Payments pursuant to this certificate shall in no way diminish, change, alter or affect the rights of EECBG or GEFA
under the contract documents.
Notary Affidavit:
Sworn to and authorized before me
CONTRACTOR
This day of 20 . By:
Date:
Notary Public
NOTICE: A COPY OF THIS WAIVER AND RELEASE SHALL BE GIVEN TO GEFA, THE EECBG, AND THE
OWNER(S) OF THE PROJECT LOCATION(S).