CONTRACTOR'S AFFIDAVIT OF
RELEASE OF LIENS
AIA Document G706 A
TO OWNER: COUNTY OF KERB
(Name and Address) 700 MAIN STREET
KERRVILLE, TX 78028
PROJECT: KERRVILLE COUNTY COURTHOUSE
(Nome and Addresry PHASE 3 RENOVATIONS
OWNER []
ARCHITECT []
CONTRACTOR []
SURETY []
OTHER []
PROJECT NO.:
CONTRACT FOR: KC3
CONTRACT DATED:
STATE OF:
COUNTY OF:
The undersigned hereby certifies that to the best of the undersigned's knowledge, information and belief, except as listed below, the Releases or
Waivers of Lien attached hereto include the ConVactor, all Subcontractors, all suppliers of materials and equipment, and all performers of Work,
labor or services who have or may have liens or encumbrances or the right to assert liens or encumbrances against any property of the Owner
arising in any manner out of the performance of the Contract referenced above.
EXCEPTIONS:
FOR PAYMENT OF $3586.76
SUPPORTING DOCUMENTS ATTACHED HERETO: SUB
1 :'fF. ('Y7. CL:s(IC
n
CONTRACTOR: UNIVERSAL FORM TOPS INC
(Name andAddress)
I. Contractor's Release or Waiver of Liens, conditional upon
receipt of final payment.
2. Separate Releases or Waiver of Liens from Subcontractors
and material and equipment suppliers, to [he extent
required by the Owner, accompanied by a list thereof.
x~{"' e LINDA IecN•FGHENNIir
` °'+^.ONiMISS;ON EXPIRES
~''~°' Dxamber11,2903
I '
BY: ° w~lJ,
(5' afore afavthori:ed repreeentanve)
~1 I ~ In~ELs hF SALF_ s
(Printed name and title)
Subscribed and sworn to be~f/o/re me'oyn~ t~hiys~d~at~e:~ ~'~j ~~ y~ ~ /.
Notary Public: ~ ~U ~i~ / I,f r / IX.C, /~-W~ ~Y U "`s2
LINDA NEMEC HENNTG 0
My commission expires: 12/11/03
AIA DOCUMENT G706A. fOV'1'it:\Ci'OR'S 4}FII1,A{'CI' Oh' HELF:.4Sk! OF LIF1tiS. 7993 4:LEC'1'RONIC SPRE:\DSHEF. I'
N:UI'PI(Iti,.41A.I993: 1'HN'.:\At 6;RICA\ INS"f 1TU'rF. OF':\RCHI'1'P:CTti, 17.14 NP.W {'012K ti0'I'.4 PHO'COCOP{'
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G706A-1994
CONTRACTOR'S AFFIDAVIT OF
RELEASE OF LIENS
AIA Document G 706 A
TO OWNF,R: KF,RR COUNTY. TX
/Name wee Addrese7 700 MAIN STREF.'C
KERRVILLE, TX 78028
PROJECT: PHASE3 RENOVATIONS 'f0
(Name mrd Addresu7 KERR CTY COURTHHOUSF,
ANNEX
700 MAIN STREET KERRVILLE, TX
PROJECT NO.:
OWNF,R [ ]
ARCHITECT I ~
CONTRACTOR [~
SURETY [J
OTHER f 1
CONTRACT FOR: PHASE3RF.NOVS
CON'fRAC 1' DATED: 02/08/99
STATE OF.
COUNTY OF:
The undersigned hereby certifies that to the besr of the undersigned's knowledge, information and belief, except as listed below, the Releases or
Waivers of Lien attached hereto include the Contractor, all Subcontractors, all suppliers of materials and equipment, and all performers of Work,
labor or services who have or may have liens or encumbrances or the right to assert liens or encumbrances against any property of the Owner
arising in any manner out of the performance of [he Contract referenced above.
EXCEPTIONS:
PAYMENT OF : 8432.70
SUPPORTING DOCUMENTS ATTACHED HERE'CO: SUB
CONTRACTOR. UNIVERSAL FORM 'COPS
/Name anAdAdresv(
1. Contractor's Release or Waiver of Liens, conditional upon
receipt of final payment.
2. Separate Releases or Waiver of Liens from Subcontractors
and material and equipment supplier, to the extent
required by the Owner, accompanied by a list thereof.
BY
ignahve ofpulhanzeJ ~epre+r nllvGl
_~,
t.tNGA NEMEGHENNIG
;~r
ry,: ,rE My ~pMMISSION EXPIRES
`:~~rr Dece!td>ar11,2003
t
W-
I-
lPnnteAnamc and litltl
Subscribed and sword [o bef}ore m"e~on~[h~isytda~te~ 11~~Q''~`''~~~~~J(~
Notary Publio: ~ lL~! / IfG~ / ~xv f~`~t V
LINDA NEMEC HENNIG
My commission expires: 12/I1/U3
RiA DOCUMENT G7DSA.fflV It N'IO)t'S AN79RAl'II t)h HI.Lti Ask OI'IJF.S9. t9y4 P:LF{ IR(Y1'1tSpRY t!)SH[. t:r
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G706A-1994