Project Management Office LIEN HOLDBACK RELEASE CERTIFICATE - PDF

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Project Management Office LIEN HOLDBACK RELEASE CERTIFICATE - PDF Powered By Docstoc
					                                                                                                      Project Management Office

                                                                            LIEN HOLDBACK RELEASE CERTIFICATE

Owner:               GOVERNORS of the UNIVERSITY OF ALBERTA                                 Lien Holdback Certificate No:
Project:                                                                                                    Contract No:
                                                                                                             Project No:
Contractor /
Subcontractor:
Consultant:


We hereby certify that, in accordance with the terms and conditions of the Contract, the Contractor/Subcontractor release of lien holdback
in the amount of ($ )                                                                                                 /100 dollars


Date of Substantial Performance Certificate
                                                      MM / DD / YYY

Account Status:

                     Total Lien Holdback to Date
                                                                                                             MM / DD / YYYY
                     Add Goods & Services Tax - 7%
                     Total Lien Holdback (including GST)




Payment Status:

                     Total Lien Holdback (including GST)
                     Lien Holdback Previously Released
                     Lien Holdback Released this Claim
                     Balance Lien Holdback Retained




                     TOTAL AMOUNT OF THIS LIEN HOLDBACK RELEASE

                     DATE OF LIEN HOLDBACK RELEASE
                                                                      MM / DD / YYY




Calculated by:
                     Prime Consultant                                                 Signature                             Date




Approved by:
                     Project Manager                                                  Signature                             Date




DISTRIBUTION:                   Name                                  Representing                           Fax Number




PMO 009 – 01/02/01 Rev: 0