Sworn Statement of a Contractor

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Sworn Statement of a Contractor Powered By Docstoc
					Sworn Statement for a Contractor

             This is a sworn statement that a contractor issues,
             stating his/her understanding of the details of the
             job, including compensation, materials, fees, timing
             and legal considerations

             Who should use this document?
                   Lawyers
                   Contractors

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          Entire document © Docstoc, Inc., 2010, 2011

              STATE OF ________________, COUNTY OF _________________________

The undersigned, being duly sworn, on oath deposes and says that (s)he is the
_________________ (Title) of the _______________________, (Firm) the contractor employed
by       _______________________ to furnish labor and materials for the
__________________work              on          the          buildings            located

The total amount of the contract is $____________ of which I have received payment of $
___________ prior to this payment; that the persons, firms, and corporations engaged by the
undersigned to have furnished services, equipment, labor and/or materials in the construction or
repair of the improvements on the Premises; that the dollar amount set opposite each such
person, firm, or corporation in this Sworn Statement is the exact and total amount due or to
become due to each such person, firm, or corporation on account of labor, services, equipment,
and/or materials furnished with respect to said Premises; that as of this date, all work to be
performed with respect to said Premises by the undersigned or any suppliers or subcontractors of
the undersigned or any of the persons, firms, or corporations named in the Schedule B of this
Sworn Statement, has been fully accepted by the owner and completed according to the plans
and specifications.

 The undersigned further states that all material (except as disclosed on said Schedule B) has
been or will be furnished from his/her own stock and has been paid for in full; that there are no
other contracts or subcontracts for said work outstanding, and that there is nothing due or to
become due to any person for services, equipment, material, labor, or any other work done or to
be done in connections with said work other than the stated on Schedule B. There are no chattel
mortgages, personal property leases, conditional sale contracts or any other agreements given are
now outstanding as to any fixtures, equipment, appliances or materials placed upon or installed
in or upon the aforementioned premises or improvements thereon. All waivers are true, correct,
and genuine and are delivered unconditionally. Furthermore, there is no claim, either legal or
equitable; to defeat the validity of said waivers.

© Copyright 2011 Docstoc Inc.                                                           2
Signed this _________ day of ___________, __________

Name: ________________________________________

Subscribed and sworn to before me this ________ day of _________________, 20 ___.

Notary Public: __________________________

My Commission Expires: ____________________

                                     SCHEDULE B

© Copyright 2010 Docstoc Inc.                                                       3
 Name and             Kind of      Amount of     Retention        Net of        Net Amount    Balance to
  Address             Work          Contract       (incl.        Previous           This     Become Due
                                                 Current)        Payments        Payment        (incl.

Amount of Original Contract     $__________________    Work Completed to Date     $__________________

Extras to Contract              $__________________    Less ______% Retained      $__________________

Total Contract & Extras         $___________________   Net Amount Earned          $__________________

Credits to Contract             $___________________

Adjusted Total Contract         $___________________   Net Previously Paid        $__________________

                                                       Net Amount of the Payment $__________________

                                                       Balance to Become Due     $___________________
                                                       (incl. Retention)

© Copyright 2010 Docstoc Inc.                                                                  4

Description: This is a sworn statement that a contractor issues, stating his/her understanding of the details of the job, including compensation, materials, fees, timing and legal considerations, to name a few
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