The form below is a demonstration of the information necessary to complete a Certificate of Substantial Completion.
AIA FORM 706 is the form that should be completed and submitted.
Affidavit of Payment of Debts and Claims
TO OWNER: Board of Trustees of the University of Arkansas acting on behalf of (insert campus name)
PROJECT CAMPUS:
(Name and address)
ARCHITECT PROJECT NO:
CONTRACT DATE:
TO CONTRACTOR:
STATE OF ARKANSAS:
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 Contractor, the 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 asset liens or encumbrances against any property of the Owner arising in any manner out of the performance of the Contract referenced above.
EXCEPTIONS:
SUPPORTING DOCUMENTS ATTACHED HERETO:
The following documents should be attached if required by the Owner.
1. Contractor’s Release or Waiver of Liens
2. Separate releases or waivers from subcontractors
CONTRACTOR:
(Name and Address)
BY: _____________________________________________________
(Signature of authorized representative)
Printed name and Title: ________________________________________
Subscribed and sworn to before me on this date: ___________________
Notary Public: _______________________________________________
My commission expires: _______________________________________