Sworn Statement for Contractor

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

SWORN STATEMENT FOR CONTRACTOR

STATE OF {{state}}

COUNTY OF {{county}}

AFFIDAVIT

I, {{contractor_name}}, being first duly sworn, depose and state as follows:

1. I am the {{title}} of {{contracting_company_name}}, located at {{contracting_company_address}} (hereinafter referred to as “the Contractor”), and am authorized to make this Sworn Statement.

2. The Contractor has entered into a contract with {{client_name}} (hereinafter referred to as “the Owner”) for the construction of {{project_description}} located at {{project_address}} (hereinafter referred to as “the Project”).

3. All work required under the aforementioned contract has been fully and completely performed in accordance with the terms and conditions thereof.

PAYMENT CERTIFICATION

4. All laborers, subcontractors, and material suppliers who have performed work or supplied materials for the Project have been paid in full, or arrangements for payment have been made, for all work performed and materials supplied up to and including the date of this statement. There are no outstanding or disputed payments due to any third parties for services rendered or materials provided in connection with the Project.

5. A complete list of all subcontractors and material suppliers, along with their respective amounts paid, is attached hereto as Exhibit A.

NO OUTSTANDING CLAIMS OR LIENS

6. I hereby declare that there are no outstanding claims, demands, liens, or encumbrances of any kind whatsoever against the Project, the Contractor, or the Owner arising out of or in connection with the work performed or materials supplied by the Contractor or any subcontractor or supplier for the Project.

7. The Contractor has complied with all applicable laws, regulations, and ordinances pertaining to the Project, including but not limited to, those concerning wages, labor practices, safety, and environmental protection.

INDEMNIFICATION

8. The Contractor agrees to indemnify and hold harmless the Owner from and against any and all claims, demands, liabilities, losses, damages, costs, and expenses (including, without limitation, reasonable attorneys' fees) arising from or in connection with any claims made by laborers, subcontractors, or material suppliers, or any other party, related to the Project and predating the date of this Sworn Statement.

DECLARATION

9. I make this sworn statement with full knowledge of the facts and of the penalties for perjury, and for the purpose of inducing the Owner to make final payment to the Contractor and/or to release any retainage held in connection with the Project.

FURTHER AFFIANT SAYETH NAUGHT.

Signature Block

_____________________________

{{contractor_name}}

{{title}}

{{contracting_company_name}}

Subscribed and sworn to before me this {{day}} day of {{month}}, {{year}}.

_____________________________

Notary Public

My Commission Expires: {{commission_expiry_date}}