Get documents about "Exhibit CDS chedule of Values Pay Request
Document Sample
INSTRUCTIONS FOR COMPLETING EXHIBITS C & D
Please follow the following instructions for completing draw requests. Failure to follow these
instruction will result in a delay in receiving payment for your work.
It is suggested that you print out these instructions along with the sheets labeled Exhibit C-1
Example, Exhibit D-1 Example, and Subsequent Exhibit C Example for reference when completing
the Schedule of Values.
1- Schedule of Values: refer to the sheet labeled "Exhibit C-1 Example" for completing the Schedule of
Values. Complete steps 1-5 on the sheet labeled "Exhibit C-1". If there have been any APPROVED
change orders during the billing period then steps 6-9 will also need to be completed. If there have been
no APPROVED change orders then steps 6-9 can be skipped. Once you have completed the previous
mentioned steps, SAVE YOUR WORK to a folder on your computer.
2- First Payment Request: refer to the sheet labeled "Exhibit D-1 Example" for completing the payment
request. Input the amount owing to each 2nd Tier Subcontractor or Supplier along with the
corresponding Company name as shown. Once you have input this information, print out both sheets
Exhibit C-1 and Exhibit D-1 and SAVE YOUR WORK. As you can see, each payment request will
require both an Exhibit C and Exhibit D. For each billing period both an Exhibit C and Exhibit D have
been provided and color coded and numbered to help you keep track of each billing period. Exhibit D
will need to be signed and notarized prior to submitting to Velocity. Once Exhibit D has been signed and
notarized, submit both Exhibit C and Exhibit D to Velocity along with all the lien waivers. The fax
number is located on Exhibit C.
3- Subsequent Payment Requests: refer to the sheet labeled "Subsequent Exhibit C Example" for
instructions on completing subsequent Payment Requests. For Payment Request number 2 use the
sheet labeled Exhibit C-2. For Payment Request number 3 use the sheet labeled Exhibit C-3, and so
on. Complete Steps 1 and 2. If there have been any APPROVED change orders for the current or prior
billing periods then steps 3-6 will also need to be completed. If there have been no APPROVED change
orders then steps 3-6 can be skipped. Once you have completed the previous mentioned steps, print
out both Exhibit C and Exhibit D and SAVE YOUR WORK. Exhibit D will need to be signed and
notarized prior to submitting to Velocity. Once Exhibit D has been signed and notarized, submit both
Exhibit C and Exhibit D to Velocity along with all the lien waivers. The fax number is located on Exhibit
C.
If you experience problems completing the Schedule of Values and Payment Request feel free to give
Robert a call. You can reach him at 435-586-0843. Don't delay on submitting your payment requests or you
may experience a delay in getting paid.
EXHIBIT C
Exhibit C-1 Example
SCHEDULE OF VALUES
Step 1-Enter Project Name
PROJECT # / NAME: Project X SUBMIT TO:
Velocity Homes, Inc.
SUBCONTRACTOR : XYZ Construction Step 2-Enter Subcontractor's P.O. Box 1977
Name Cedar City, Utah for the
Step 4-Enter the end date84720 billing period.
PAYMENT REQUEST NO.: 1 Phone: 435-586-0843
Although the Pay Request has to be submitted
Fax: 435-586-4968
by the 20th of each month, work can be billed
PERIOD FROM: 1-Apr-08 TO 30-Apr-08
up to the end of the month
Step 3-Enter the
beginning date for the
A B C D E F G
billing period VALUE OF WORK COMPLETED
ITEM NO. DESCRIPTION OF WORK SCHEDULED FROM TOTAL %
VALUE PREVIOUS THIS PERIOD TO DATE COMPLETE
APPLICATIONS (D+E) (F/C)
1 Footings $ 2,000.00 $ 2,000.00 $ 2,000.00 100.00%
2 Walls $ 8,000.00 $ 8,000.00 $ 8,000.00 100.00%
3 Interior Concrete Slab $ 9,000.00 $ 6,000.00 $ 6,000.00 66.67%
4 Suspended Concrete Slab $ 15,000.00 $ - 0.00%
5 Exterior Concrete $ 5,000.00 $ - 0.00%
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
Step 5-Enter the$value for - #DIV/0!
work completed$in the - #DIV/0!
$
current billing period - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
This amount should equal the $ - #DIV/0!
$ - #DIV/0!
Original Contracted amount
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
SUBCONTRACT AMOUNT $ 39,000.00 $ - $ 16,000.00 $ 16,000.00 41.03%
*EXHIBIT D LINE 1
ITEM NO. APPROVED CHANGE ORDERS
1 8' Foundation Walls to 10' Walls $ 1,300.00 $ 1,300.00 $ 1,300.00 100.00%
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
Step 6-Enter the Item Step 7-Describe the work to Step 8-Enter the Value for Step 9-Enter the$value for - #DIV/0!
Number for APPROVED be done for each APPROVED work to be done for each work completed$in the - #DIV/0!
Change Orders for the Change Order item number item current billing period
$ - #DIV/0!
current billing period $ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
APPROVED Change Orders are those that
$ - #DIV/0!
have been signed by both the Owner and
$ - #DIV/0!
Contractor $ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
$ - #DIV/0!
APPROVED CHANGE ORDER(S) $ 1,300.00 $ - $ 1,300.00 $ 1,300.00 100.00%
** EXHIBIT D LINE 2
ADJUSTED SUBCONTRACT AMOUNT $ 40,300.00 $ - $ 17,300.00 $ 17,300.00 42.93%
***EXHIBIT D LINE 3 **** EXHIBIT D LINE 4
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT D
PAY REQUEST & CONDITIONAL LIEN RELEASE Exhibit D Example
PROJECT # / NAME: Project X
SUBCONTRACTOR : XYZ Construction
PAYMENT REQUEST NO.: 1
PERIOD FROM: 1-Apr-08 TO 30-Apr-08
STATEMENT OF CONTRACT VALUE
1. Original Subcontract Amount * $ 39,000.00
2. Approved Change Orders (net) (Add/Deduct) ** $ 1,300.00
3. Adjusted Subcontract Amount to Date *** $ 40,300.00
P.M. Approval
PROGRESS BILLING
4. Work Completed Subcontract Amount 43% to date **** $ 17,300.00
P.M. Approval
5. Less Retention to Date 0% ($ 0.00 )
6. Total Work Less Retention $ 17,300.00
7. Less Previous Payments ($ 0.00 )
8. AMOUNT DUE THIS REQUEST $ 17,300.00 Input 2nd Tier Subcontractor / Supplier lien
waiver amounts and Company Names. A lien
9. Less Amount Owed to 2nd Tier Subcontractor / Supplier ($ 3,567.59 ) Concrete Suppliers Inc.
waiver will need to be acquired for each
($ 0.00 ) ABC Inc. company you have listed on Exhibit H. Even if
($ ) no amount is owing, a signed waiver needs to
be attached and listed on Exhibit D.
($ )
(Requests are due by the 20th of the Month)
Schedule of Values Must Accompany This Request (Exhibit C)
CERTIFICATE OF THE SUBCONTRACTOR
To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien
or right under Utah Code Ann., Title 38, Chapter 1, Mechanic's Liens, or any bond right under Utah Code Ann., Title 14, Contractor's Bonds,
or Section 63-56-504 related to payment rights the undersigned has on the above described Property once:
(1) the undersigned receives a check in the above referenced Payment Amount payable to the undersigned;
(2) the check is properly endorsed; and
(3) the check is paid by the depository institution on which it is drawn.
This waiver and release applies to a progress payment for the work, materials, equipment, or a combination of work, materials, and equipment
furnished by the undersigned to the Property or to the Undersigned's Customer which are the subject of the Invoice or Payment
Application, buy only to the extent of the Payment Amount. This waiver and release does not apply to any retention withheld; any items,
modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after payment period.
The undersigned warrants that the undersigned either has already paid or will use the money the undersigned receives from this
progress payment promptly to pay in full all the undersigned's laborers, subcontractor's material men, and suppliers for all work, materials,
equipment, or combination of work, materials, and equipment that are the subject of this waiver and release.
I also certify that payments in full, less applicable retention, have been made through the period covered by the previous payments
received from the Contractor, to all my subcontractors, leasee's, consultants, vendors, and others for all materials and labor used in
or in connection with the performance of the Contract. I further certify I have complied with all Federal, State, and local laws, including
Social Security laws, Unemployment Compensation laws and tax laws insofar as applicable to the performance of the Contract.
CONDITIONAL WAVIER AND RELEASE OF LIEN RIGHTS
Company: Date:
Signature:
Title:
STATE OF UTAH )
:ss.
COUNTY OF _______________________ )
On the ________day of _______, 200__, personally appeared before me the individual who signed the foregoing wavier, who being duly sworn,
did say that s/he is the authorized representative and that the execution was the voluntary act and deed of the above named company.
Further, if the company is a corporation, the said individual certified that s/he is an officer duly authorized to execute the same on behalf of such
corporation.
Notary Public
445b53cc-9618-4130-af7e-26087880c0d6.xls
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT C
Subsequent Exhibit C
SCHEDULE OF VALUES
Example
PROJECT # / NAME: Project X SUBMIT TO:
Velocity Homes, Inc.
SUBCONTRACTOR : XYZ Construction P.O. Box 1977
1-Enter the Utah 84720
Step Cedar City, end date for the billing period.
PAYMENT REQUEST NO.: 2 Phone: Pay Request has
Although the435-586-0843 to be submitted
Fax: 435-586-4968
by the 20th of each month, work can be billed
PERIOD FROM: 1-May-08 TO 31-May-08
up to the end of the month.
A B C D E F G
VALUE OF WORK COMPLETED
ITEM NO. DESCRIPTION OF WORK SCHEDULED FROM TOTAL %
VALUE PREVIOUS THIS PERIOD TO DATE COMPLETE
APPLICATIONS (D+E) (F/C)
1 Footings $ 2,000.00 $ 2,000.00 $ 2,000.00 100.00%
2 Walls $ 8,000.00 $ 8,000.00 $ 8,000.00 100.00%
3 Interior Concrete Slab $ 9,000.00 $ 6,000.00 $ 3,000.00 $ 9,000.00 100.00%
4 Suspended Concrete Slab $ 15,000.00 $ - $ 15,000.00 $ 15,000.00 100.00%
5 Exterior Concrete $ 5,000.00 $ - $ - 0.00%
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
No more work should be added in this $ - Step 2-Enter the$ value for - #VALUE!
$ -
section. If additional work is done it work completed$ the
in - #VALUE!
should be input in the Change Order $ - $ - #VALUE!
current billing period.
section below. $ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
This amount should always
$ - $ - #VALUE!
equal the original $ - $ - #VALUE!
contracted amount. $ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
SUBCONTRACT AMOUNT $ 39,000.00 $ 16,000.00 $ 18,000.00 $ 34,000.00 87.18%
*EXHIBIT D LINE 1
ITEM NO. APPROVED CHANGE ORDERS
1 8' Foundation Walls to 10' Walls $ 1,300.00 $ 1,300.00 $ - $ 1,300.00 100.00%
2 Additional sidewalk $ 600.00 $ - $ 300.00 $ 300.00 50.00%
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
Step 3-Enter the Item Step 4-Describe the work to be Step 5-Enter the Value for-
$ Step 6-Enter the$value for - #VALUE!
Number for any APPROVED done for each APPROVED work to be done for each -
$ work completed in the
$ - #VALUE!
Change Orders for the Change Order item number item $ - current billing period.
$ - #VALUE!
current billing period. $ - $ - #VALUE!
$ - $ - #VALUE!
APPROVED Change Orders are$those that - $ - #VALUE!
$ - $ - #VALUE!
have been signed by both the Owner and
$ - $ - #VALUE!
Contractor $ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
APPROVED CHANGE ORDER(S) $ 1,900.00 $ 1,300.00 $ 300.00 $ 1,600.00 $ 0.84
** EXHIBIT D LINE 2
ADJUSTED SUBCONTRACT AMOUNT $ 40,900.00 $ 17,300.00 $ 18,300.00 $ 35,600.00 87.04%
***EXHIBIT D LINE 3 **** EXHIBIT D LINE 4
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT C
SCHEDULE OF VALUES
PROJECT # / NAME: SUBMIT TO:
Velocity Homes, Inc.
SUBCONTRACTOR : P.O. Box 1977
Cedar City, Utah 84720
PAY REQUEST NO.: 1 Phone: 435-586-0843
Fax: 435-586-4968
PERIOD FROM: TO
A B C D E F G
VALUE OF WORK COMPLETED
ITEM NO. DESCRIPTION OF WORK SCHEDULED FROM TOTAL %
VALUE PREVIOUS THIS PERIOD TO DATE COMPLETE
APPLICATIONS (D+E) (F/C)
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
*EXHIBIT D LINE 1
APPROVED CHANGE ORDERS
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
$ - $ - #DIV/0!
APPROVED CHANGE ORDER(S) $ - $ - $ - $ - #DIV/0!
** EXHIBIT D (LINE 2)
ADJUSTED SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
***EXHIBIT D LINE 3 **** EXHIBIT D LINE 4
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT D
PAY REQUEST & CONDITIONAL LIEN RELEASE
PROJECT # / NAME:
SUBCONTRACTOR :
PAYMENT REQUEST NO.: 1
PERIOD FROM: 0-Jan-00 TO 0-Jan-00
STATEMENT OF CONTRACT VALUE
1. Original Subcontract Amount * $ 0.00
2. Approved Change Orders (net) (Add/Deduct) ** $ 0.00
3. Adjusted Subcontract Amount to Date *** $ 0.00
Approval
PROGRESS BILLING
4. Work Completed Subcontract Amount #DIV/0! to date **** $ 0.00
Approval
5. Less Retention to Date 0% ($ 0.00 )
6. Total Work Less Retention $ 0.00
7. Less Previous Payments ($ 0.00 )
8. AMOUNT DUE THIS REQUEST $ 0.00
9. Less Amount Owed to 2nd Tier Subcontractor / Supplier ($ )
($ )
($ )
($ )
(Requests are due by the 20th of the Month)
Schedule of Values Must Accompany This Request (Exhibit C)
CERTIFICATE OF THE SUBCONTRACTOR
To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien
or right under Utah Code Ann., Title 38, Chapter 1, Mechanic's Liens, or any bond right under Utah Code Ann., Title 14, Contractor's Bonds,
or Section 63-56-504 related to payment rights the undersigned has on the above described Property once:
(1) the undersigned receives a check in the above referenced Payment Amount payable to the undersigned;
(2) the check is properly endorsed; and
(3) the check is paid by the depository institution on which it is drawn.
This waiver and release applies to a progress payment for the work, materials, equipment, or a combination of work, materials, and equipment
furnished by the undersigned to the Property or to the Undersigned's Customer which are the subject of the Invoice or Payment
Application, buy only to the extent of the Payment Amount. This waiver and release does not apply to any retention withheld; any items,
modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after payment period.
The undersigned warrants that the undersigned either has already paid or will use the money the undersigned receives from this
progress payment promptly to pay in full all the undersigned's laborers, subcontractor's material men, and suppliers for all work, materials,
equipment, or combination of work, materials, and equipment that are the subject of this waiver and release.
I also certify that payments in full, less applicable retention, have been made through the period covered by the previous payments
received from the Contractor, to all my subcontractors, leasee's, consultants, vendors, and others for all materials and labor used in
or in connection with the performance of the Contract. I further certify I have complied with all Federal, State, and local laws, including
Social Security laws, Unemployment Compensation laws and tax laws insofar as applicable to the performance of the Contract.
CONDITIONAL WAVIER AND RELEASE OF LIEN RIGHTS
Company: Date:
Signature:
Title:
STATE OF UTAH )
:ss.
COUNTY OF _______________________ )
On the ________day of _______, 200__, personally appeared before me the individual who signed the foregoing wavier, who being duly sworn,
did say that s/he is the authorized representative and that the execution was the voluntary act and deed of the above named company.
Further, if the company is a corporation, the said individual certified that s/he is an officer duly authorized to execute the same on behalf of such
corporation.
Notary Public
445b53cc-9618-4130-af7e-26087880c0d6.xls
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT C
SCHEDULE OF VALUES
PROJECT # / NAME: SUBMIT TO:
Velocity Homes, Inc.
SUBCONTRACTOR : P.O. Box 1977
Cedar City, Utah 84720
PAY REQUEST NO.: 2 Phone: 435-586-0843
Fax: 435-586-4968
PERIOD FROM: 1-Jan-00 TO
A B C D E F G
VALUE OF WORK COMPLETED
ITEM NO. DESCRIPTION OF WORK SCHEDULED FROM TOTAL %
VALUE PREVIOUS THIS PERIOD TO DATE COMPLETE
APPLICATIONS (D+E) (F/C)
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
*EXHIBIT D LINE 1
APPROVED CHANGE ORDERS
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
APPROVED CHANGE ORDER(S) $ - $ - $ - $ - #DIV/0!
** EXHIBIT D (LINE 2)
ADJUSTED SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
***EXHIBIT D LINE 3 **** EXHIBIT D LINE 4
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT D
PAY REQUEST & CONDITIONAL LIEN RELEASE
PROJECT # / NAME:
SUBCONTRACTOR :
PAYMENT REQUEST NO.: 2
PERIOD FROM: 1-Jan-00 TO 0-Jan-00
STATEMENT OF CONTRACT VALUE
1. Original Subcontract Amount * $ 0.00
2. Approved Change Orders (net) (Add/Deduct) ** $ 0.00
3. Adjusted Subcontract Amount to Date *** $ 0.00
Approval
PROGRESS BILLING
4. Work Completed Subcontract Amount #DIV/0! to date **** $ 0.00
Approval
5. Less Retention to Date 0% ($ 0.00 )
6. Total Work Less Retention $ 0.00
7. Less Previous Payments ($ 0.00 )
8. AMOUNT DUE THIS REQUEST $ 0.00
9. Less Amount Owed to 2nd Tier Subcontractor / Supplier ($ )
($ )
($ )
($ )
(Requests are due by the 20th of the Month)
Schedule of Values Must Accompany This Request (Exhibit C)
CERTIFICATE OF THE SUBCONTRACTOR
To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien
or right under Utah Code Ann., Title 38, Chapter 1, Mechanic's Liens, or any bond right under Utah Code Ann., Title 14, Contractor's Bonds,
or Section 63-56-504 related to payment rights the undersigned has on the above described Property once:
(1) the undersigned receives a check in the above referenced Payment Amount payable to the undersigned;
(2) the check is properly endorsed; and
(3) the check is paid by the depository institution on which it is drawn.
This waiver and release applies to a progress payment for the work, materials, equipment, or a combination of work, materials, and equipment
furnished by the undersigned to the Property or to the Undersigned's Customer which are the subject of the Invoice or Payment
Application, buy only to the extent of the Payment Amount. This waiver and release does not apply to any retention withheld; any items,
modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after payment period.
The undersigned warrants that the undersigned either has already paid or will use the money the undersigned receives from this
progress payment promptly to pay in full all the undersigned's laborers, subcontractor's material men, and suppliers for all work, materials,
equipment, or combination of work, materials, and equipment that are the subject of this waiver and release.
I also certify that payments in full, less applicable retention, have been made through the period covered by the previous payments
received from the Contractor, to all my subcontractors, leasee's, consultants, vendors, and others for all materials and labor used in
or in connection with the performance of the Contract. I further certify I have complied with all Federal, State, and local laws, including
Social Security laws, Unemployment Compensation laws and tax laws insofar as applicable to the performance of the Contract.
CONDITIONAL WAVIER AND RELEASE OF LIEN RIGHTS
Company: Date:
Signature:
Title:
STATE OF UTAH )
:ss.
COUNTY OF _______________________ )
On the ________day of _______, 200__, personally appeared before me the individual who signed the foregoing wavier, who being duly sworn,
did say that s/he is the authorized representative and that the execution was the voluntary act and deed of the above named company.
Further, if the company is a corporation, the said individual certified that s/he is an officer duly authorized to execute the same on behalf of such
corporation.
Notary Public
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT C
SCHEDULE OF VALUES
PROJECT # / NAME: SUBMIT TO:
Velocity Homes, Inc.
SUBCONTRACTOR : P.O. Box 1977
Cedar City, Utah 84720
PAY REQUEST NO.: 3 Phone: 435-586-0843
Fax: 435-586-4968
PERIOD FROM: 1-Jan-00 TO
A B C D E F G
VALUE OF WORK COMPLETED
ITEM NO. DESCRIPTION OF WORK SCHEDULED FROM TOTAL %
VALUE PREVIOUS THIS PERIOD TO DATE COMPLETE
APPLICATIONS (D+E) (F/C)
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
*EXHIBIT D LINE 1
APPROVED CHANGE ORDERS
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
APPROVED CHANGE ORDER(S) $ - $ - $ - $ - #DIV/0!
** EXHIBIT D (LINE 2)
ADJUSTED SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
***EXHIBIT D LINE 3 **** EXHIBIT D LINE 4
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT D
PAY REQUEST & CONDITIONAL LIEN RELEASE
PROJECT # / NAME:
SUBCONTRACTOR :
PAYMENT REQUEST NO.: 3
PERIOD FROM: 1-Jan-00 TO 0-Jan-00
STATEMENT OF CONTRACT VALUE
1. Original Subcontract Amount * $ 0.00
2. Approved Change Orders (net) (Add/Deduct) ** $ 0.00
3. Adjusted Subcontract Amount to Date *** $ 0.00
Approval
PROGRESS BILLING
4. Work Completed Subcontract Amount #DIV/0! to date **** $ 0.00
Approval
5. Less Retention to Date 0% ($ 0.00 )
6. Total Work Less Retention $ 0.00
7. Less Previous Payments ($ 0.00 )
8. AMOUNT DUE THIS REQUEST $ 0.00
9. Less Amount Owed to 2nd Tier Subcontractor / Supplier ($ )
($ )
($ )
($ )
(Requests are due by the 20th of the Month)
Schedule of Values Must Accompany This Request (Exhibit C)
CERTIFICATE OF THE SUBCONTRACTOR
To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien
or right under Utah Code Ann., Title 38, Chapter 1, Mechanic's Liens, or any bond right under Utah Code Ann., Title 14, Contractor's Bonds,
or Section 63-56-504 related to payment rights the undersigned has on the above described Property once:
(1) the undersigned receives a check in the above referenced Payment Amount payable to the undersigned;
(2) the check is properly endorsed; and
(3) the check is paid by the depository institution on which it is drawn.
This waiver and release applies to a progress payment for the work, materials, equipment, or a combination of work, materials, and equipment
furnished by the undersigned to the Property or to the Undersigned's Customer which are the subject of the Invoice or Payment
Application, buy only to the extent of the Payment Amount. This waiver and release does not apply to any retention withheld; any items,
modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after payment period.
The undersigned warrants that the undersigned either has already paid or will use the money the undersigned receives from this
progress payment promptly to pay in full all the undersigned's laborers, subcontractor's material men, and suppliers for all work, materials,
equipment, or combination of work, materials, and equipment that are the subject of this waiver and release.
I also certify that payments in full, less applicable retention, have been made through the period covered by the previous payments
received from the Contractor, to all my subcontractors, leasee's, consultants, vendors, and others for all materials and labor used in
or in connection with the performance of the Contract. I further certify I have complied with all Federal, State, and local laws, including
Social Security laws, Unemployment Compensation laws and tax laws insofar as applicable to the performance of the Contract.
CONDITIONAL WAVIER AND RELEASE OF LIEN RIGHTS
Company: Date:
Signature:
Title:
STATE OF UTAH )
:ss.
COUNTY OF _______________________ )
On the ________day of _______, 200__, personally appeared before me the individual who signed the foregoing wavier, who being duly sworn,
did say that s/he is the authorized representative and that the execution was the voluntary act and deed of the above named company.
Further, if the company is a corporation, the said individual certified that s/he is an officer duly authorized to execute the same on behalf of such
corporation.
Notary Public
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT C
SCHEDULE OF VALUES
PROJECT # / NAME: SUBMIT TO:
Velocity Homes, Inc.
SUBCONTRACTOR : P.O. Box 1977
Cedar City, Utah 84720
PAY REQUEST NO.: 4 Phone: 435-586-0843
Fax: 435-586-4968
PERIOD FROM: 1-Jan-00 TO
A B C D E F G
VALUE OF WORK COMPLETED
ITEM NO. DESCRIPTION OF WORK SCHEDULED FROM TOTAL %
VALUE PREVIOUS THIS PERIOD TO DATE COMPLETE
APPLICATIONS (D+E) (F/C)
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
*EXHIBIT D LINE 1
APPROVED CHANGE ORDERS
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
APPROVED CHANGE ORDER(S) $ - $ - $ - $ - #DIV/0!
** EXHIBIT D (LINE 2)
ADJUSTED SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
***EXHIBIT D LINE 3 **** EXHIBIT D LINE 4
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT D
PAY REQUEST & CONDITIONAL LIEN RELEASE
PROJECT # / NAME:
SUBCONTRACTOR :
PAYMENT REQUEST NO.: 4
PERIOD FROM: 1-Jan-00 TO 0-Jan-00
STATEMENT OF CONTRACT VALUE
1. Original Subcontract Amount * $ 0.00
2. Approved Change Orders (net) (Add/Deduct) ** $ 0.00
3. Adjusted Subcontract Amount to Date *** $ 0.00
Approval
PROGRESS BILLING
4. Work Completed Subcontract Amount #DIV/0! to date **** $ 0.00
Approval
5. Less Retention to Date 0% ($ 0.00 )
6. Total Work Less Retention $ 0.00
7. Less Previous Payments ($ 0.00 )
8. AMOUNT DUE THIS REQUEST $ 0.00
9. Less Amount Owed to 2nd Tier Subcontractor / Supplier ($ )
($ )
($ )
($ )
(Requests are due by the 20th of the Month)
Schedule of Values Must Accompany This Request (Exhibit C)
CERTIFICATE OF THE SUBCONTRACTOR
To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien
or right under Utah Code Ann., Title 38, Chapter 1, Mechanic's Liens, or any bond right under Utah Code Ann., Title 14, Contractor's Bonds,
or Section 63-56-504 related to payment rights the undersigned has on the above described Property once:
(1) the undersigned receives a check in the above referenced Payment Amount payable to the undersigned;
(2) the check is properly endorsed; and
(3) the check is paid by the depository institution on which it is drawn.
This waiver and release applies to a progress payment for the work, materials, equipment, or a combination of work, materials, and equipment
furnished by the undersigned to the Property or to the Undersigned's Customer which are the subject of the Invoice or Payment
Application, buy only to the extent of the Payment Amount. This waiver and release does not apply to any retention withheld; any items,
modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after payment period.
The undersigned warrants that the undersigned either has already paid or will use the money the undersigned receives from this
progress payment promptly to pay in full all the undersigned's laborers, subcontractor's material men, and suppliers for all work, materials,
equipment, or combination of work, materials, and equipment that are the subject of this waiver and release.
I also certify that payments in full, less applicable retention, have been made through the period covered by the previous payments
received from the Contractor, to all my subcontractors, leasee's, consultants, vendors, and others for all materials and labor used in
or in connection with the performance of the Contract. I further certify I have complied with all Federal, State, and local laws, including
Social Security laws, Unemployment Compensation laws and tax laws insofar as applicable to the performance of the Contract.
CONDITIONAL WAVIER AND RELEASE OF LIEN RIGHTS
Company: Date:
Signature:
Title:
STATE OF UTAH )
:ss.
COUNTY OF _______________________ )
On the ________day of _______, 200__, personally appeared before me the individual who signed the foregoing wavier, who being duly sworn,
did say that s/he is the authorized representative and that the execution was the voluntary act and deed of the above named company.
Further, if the company is a corporation, the said individual certified that s/he is an officer duly authorized to execute the same on behalf of such
corporation.
Notary Public
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT C
SCHEDULE OF VALUES
PROJECT # / NAME: SUBMIT TO:
Velocity Homes, Inc.
SUBCONTRACTOR : P.O. Box 1977
Cedar City, Utah 84720
PAY REQUEST NO.: 5 Phone: 435-586-0843
Fax: 435-586-4968
PERIOD FROM: 1-Jan-00 TO
A B C D E F G
VALUE OF WORK COMPLETED
ITEM NO. DESCRIPTION OF WORK SCHEDULED FROM TOTAL %
VALUE PREVIOUS THIS PERIOD TO DATE COMPLETE
APPLICATIONS (D+E) (F/C)
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
*EXHIBIT D LINE 1
APPROVED CHANGE ORDERS
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
APPROVED CHANGE ORDER(S) $ - $ - $ - $ - #DIV/0!
** EXHIBIT D (LINE 2)
ADJUSTED SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
***EXHIBIT D LINE 3 **** EXHIBIT D LINE 4
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT D
PAY REQUEST & CONDITIONAL LIEN RELEASE
PROJECT # / NAME:
SUBCONTRACTOR :
PAYMENT REQUEST NO.: 5
PERIOD FROM: 1-Jan-00 TO 0-Jan-00
STATEMENT OF CONTRACT VALUE
1. Original Subcontract Amount * $ 0.00
2. Approved Change Orders (net) (Add/Deduct) ** $ 0.00
3. Adjusted Subcontract Amount to Date *** $ 0.00
Approval
PROGRESS BILLING
4. Work Completed Subcontract Amount #DIV/0! to date **** $ 0.00
Approval
5. Less Retention to Date 0% ($ 0.00 )
6. Total Work Less Retention $ 0.00
7. Less Previous Payments ($ 0.00 )
8. AMOUNT DUE THIS REQUEST $ 0.00
9. Less Amount Owed to 2nd Tier Subcontractor / Supplier ($ )
($ )
($ )
($ )
(Requests are due by the 20th of the Month)
Schedule of Values Must Accompany This Request (Exhibit C)
CERTIFICATE OF THE SUBCONTRACTOR
To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien
or right under Utah Code Ann., Title 38, Chapter 1, Mechanic's Liens, or any bond right under Utah Code Ann., Title 14, Contractor's Bonds,
or Section 63-56-504 related to payment rights the undersigned has on the above described Property once:
(1) the undersigned receives a check in the above referenced Payment Amount payable to the undersigned;
(2) the check is properly endorsed; and
(3) the check is paid by the depository institution on which it is drawn.
This waiver and release applies to a progress payment for the work, materials, equipment, or a combination of work, materials, and equipment
furnished by the undersigned to the Property or to the Undersigned's Customer which are the subject of the Invoice or Payment
Application, buy only to the extent of the Payment Amount. This waiver and release does not apply to any retention withheld; any items,
modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after payment period.
The undersigned warrants that the undersigned either has already paid or will use the money the undersigned receives from this
progress payment promptly to pay in full all the undersigned's laborers, subcontractor's material men, and suppliers for all work, materials,
equipment, or combination of work, materials, and equipment that are the subject of this waiver and release.
I also certify that payments in full, less applicable retention, have been made through the period covered by the previous payments
received from the Contractor, to all my subcontractors, leasee's, consultants, vendors, and others for all materials and labor used in
or in connection with the performance of the Contract. I further certify I have complied with all Federal, State, and local laws, including
Social Security laws, Unemployment Compensation laws and tax laws insofar as applicable to the performance of the Contract.
CONDITIONAL WAVIER AND RELEASE OF LIEN RIGHTS
Company: Date:
Signature:
Title:
STATE OF UTAH )
:ss.
COUNTY OF _______________________ )
On the ________day of _______, 200__, personally appeared before me the individual who signed the foregoing wavier, who being duly sworn,
did say that s/he is the authorized representative and that the execution was the voluntary act and deed of the above named company.
Further, if the company is a corporation, the said individual certified that s/he is an officer duly authorized to execute the same on behalf of such
corporation.
Notary Public
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT C
SCHEDULE OF VALUES
PROJECT # / NAME: SUBMIT TO:
Velocity Homes, Inc.
SUBCONTRACTOR : P.O. Box 1977
Cedar City, Utah 84720
PAY REQUEST NO.: 6 Phone: 435-586-0843
Fax: 435-586-4968
PERIOD FROM: 1-Jan-00 TO
A B C D E F G
VALUE OF WORK COMPLETED
ITEM NO. DESCRIPTION OF WORK SCHEDULED FROM TOTAL %
VALUE PREVIOUS THIS PERIOD TO DATE COMPLETE
APPLICATIONS (D+E) (F/C)
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
*EXHIBIT D LINE 1
APPROVED CHANGE ORDERS
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
$ - $ - #VALUE!
APPROVED CHANGE ORDER(S) $ - $ - $ - $ - #DIV/0!
** EXHIBIT D (LINE 2)
ADJUSTED SUBCONTRACT AMOUNT $ - $ - $ - $ - #DIV/0!
***EXHIBIT D LINE 3 **** EXHIBIT D LINE 4
445b53cc-9618-4130-af7e-26087880c0d6.xls
EXHIBIT D
PAY REQUEST & CONDITIONAL LIEN RELEASE
PROJECT # / NAME:
SUBCONTRACTOR :
PAYMENT REQUEST NO.: 6
PERIOD FROM: 1-Jan-00 TO 0-Jan-00
STATEMENT OF CONTRACT VALUE
1. Original Subcontract Amount * $ 0.00
2. Approved Change Orders (net) (Add/Deduct) ** $ 0.00
3. Adjusted Subcontract Amount to Date *** $ 0.00
Approval
PROGRESS BILLING
4. Work Completed Subcontract Amount #DIV/0! to date **** $ 0.00
Approval
5. Less Retention to Date 0% ($ 0.00 )
6. Total Work Less Retention $ 0.00
7. Less Previous Payments ($ 0.00 )
8. AMOUNT DUE THIS REQUEST $ 0.00
9. Less Amount Owed to 2nd Tier Subcontractor / Supplier ($ )
($ )
($ )
($ )
(Requests are due by the 20th of the Month)
Schedule of Values Must Accompany This Request (Exhibit C)
CERTIFICATE OF THE SUBCONTRACTOR
To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien
or right under Utah Code Ann., Title 38, Chapter 1, Mechanic's Liens, or any bond right under Utah Code Ann., Title 14, Contractor's Bonds,
or Section 63-56-504 related to payment rights the undersigned has on the above described Property once:
(1) the undersigned receives a check in the above referenced Payment Amount payable to the undersigned;
(2) the check is properly endorsed; and
(3) the check is paid by the depository institution on which it is drawn.
This waiver and release applies to a progress payment for the work, materials, equipment, or a combination of work, materials, and equipment
furnished by the undersigned to the Property or to the Undersigned's Customer which are the subject of the Invoice or Payment
Application, buy only to the extent of the Payment Amount. This waiver and release does not apply to any retention withheld; any items,
modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after payment period.
The undersigned warrants that the undersigned either has already paid or will use the money the undersigned receives from this
progress payment promptly to pay in full all the undersigned's laborers, subcontractor's material men, and suppliers for all work, materials,
equipment, or combination of work, materials, and equipment that are the subject of this waiver and release.
I also certify that payments in full, less applicable retention, have been made through the period covered by the previous payments
received from the Contractor, to all my subcontractors, leasee's, consultants, vendors, and others for all materials and labor used in
or in connection with the performance of the Contract. I further certify I have complied with all Federal, State, and local laws, including
Social Security laws, Unemployment Compensation laws and tax laws insofar as applicable to the performance of the Contract.
CONDITIONAL WAVIER AND RELEASE OF LIEN RIGHTS
Company: Date:
Signature:
Title:
STATE OF UTAH )
:ss.
COUNTY OF _______________________ )
On the ________day of _______, 200__, personally appeared before me the individual who signed the foregoing wavier, who being duly sworn,
did say that s/he is the authorized representative and that the execution was the voluntary act and deed of the above named company.
Further, if the company is a corporation, the said individual certified that s/he is an officer duly authorized to execute the same on behalf of such
corporation.
Notary Public
445b53cc-9618-4130-af7e-26087880c0d6.xls
