Lien Release, Certification of Payment and Subcontractor
Whereas, the undersigned _______________________________ (Contractor) having its place of business at __________________________________________ (Address) has furnished or caused to be furnished certain materials, equipment, services and / or labor in connection with Contract number ____________ and Project Title _________________ which is being provided for Stony Brook University (Owner), pursuant to Owner’s agreement with Contractor. Contractor does hereby: Certify that all laborers, workers, and mechanics employed on said project were paid the wages and supplements recorded as earned on the attached payroll records. No deductions have been made either directly or indirectly from the wages and supplements other than deductions shown on the payroll records. The payroll records submitted for the above period and attached hereto are correct and complete. The number of hours shown for each employee reflects the actual hours worked by that employee. The classification shown for each employee is accurate and conforms to the work he or she performed. Certify that there are no known mechanics’ or materialmen’s liens outstanding at the date of this invoice, that all due and payable bills with respect to the work have been paid to date or are included in the amount requested in the current invoice, and that, except for such bills not paid but so included, there is no known basis for the filing of any mechanics’ or materialmen’s liens on the services/material, and that waivers from all subcontractors and materialmen have been obtained in such forms as to constitute a waiver of lien under the laws of the State of New York for all preceding payments. Waive and release any and all liens or claims of liens it has upon the foregoing described Project through the date of the invoice. Contractor hereby certifies that no subcontractors were utilized in the project billed on the attached invoice. Contractor hereby certifies that subcontractors were utilized in the project billed on the attached invoice and all certified payroll is complete and attached.
_______________________________ Name and Title
______________________________ __________ Signature Date
The willful falsification of any of the above statements may subject the signatory of this certification and contractor or subcontractor to civil or criminal prosecution.
PROC0013 (06/06)
www.stonybrook.edu/procurement