Sworn Statement of a Contractor

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Sworn Statement of a Contractor Powered By Docstoc
					This is a sworn statement provided by a contractor affirming that they understand the
duties and specifications of the job they were hired to perform for the customer. This
statement includes a “Schedule A” that provides the details of the services, equipment,
labor, and materials related to the project. An estimate of the costs of the labor and the
materials are also included “Schedule A.” This statement can be used by contactors to
affirm they understand the project’s objectives and they are providing accurate
estimates.
                      SWORN STATEMENT FOR A CONTRACTOR

      STATE OF ________________, [Instruction: insert name of state] COUNTY OF
           _________________________ [Instruction: insert name of county]

The undersigned, being duly sworn, on oath deposes and says that (s)he is the
_________________ [Instruction: insert title of contractor] (Title) of the
_______________________, [Instruction: insert name of contractor’s firm] (Firm), the
contractor having been hired by _______________________ [Instruction: insert the name of
the individual or company that has hired the Contractor] (the “Owner”) to furnish labor and
materials for the __________________ [Instruction: insert the title or a brief description of
the        project]         work          on         the  buildings         located       at:
__________________________________________ [Instruction: insert the address where the
project will take place] (hereinafter the “Project”).

The total amount of the contract is _________________ ($_______) [Instruction: insert dollar
amount], of which I have received payment of ___________________ ($_______) [Instruction:
insert dollar amount] as of the date of my signature below. The persons, firms, and
corporations that I intend to engage to furnish services, equipment, labor and/or materials related
to the Project are identified on Schedule A attached hereto. The dollar amount set opposite each
such person, firm, or corporation on Schedule A is the estimated amount that will be due or to
each such person, firm, or corporation on account of labor, services, equipment, and/or materials
furnished with respect to the Project. As of this date, all work to be performed with respect to
the Project by the undersigned or any suppliers or subcontractors of the undersigned or any of the
persons, firms, or corporations named in the Schedule A of this Sworn Statement, has been fully
accepted by the Owner.

The undersigned further states that all material (except as disclosed on said Schedule A) 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 that stated on Schedule A. 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.

I, ________________ [Instruction: insert Contractor’s name] affirm and declare under
penalty of perjury under the laws of the State of ________ [Instruction: insert name of state],
that the information I have provided is true and complete to the best of my knowledge.
Furthermore, I have made these statements without threat, coercion or unlawful influence, or
inducement.

Signed this _________ day of ___________, __________ [Instruction: insert date]
________________________________________


Notary

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

Notary Public: __________________________, County of __________, ____________ [Insert
County and State]

My Commission Expires: ____________________




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                                               SCHEDULE A


 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.
                                                                                             Retentions)




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 2011 Docstoc Inc.                                                                  4

				
DOCUMENT INFO
Description: This is a sworn statement provided by a contractor affirming that they understand the duties and specifications of the job they were hired to perform for the customer. This statement includes a “Schedule A” that provides the details of the services, equipment, labor, and materials related to the project. An estimate of the costs of the labor and the materials are also included “Schedule A.” This statement can be used by contactors to affirm they understand the project’s objectives and they are providing accurate estimates.
This document is also part of a package Independent Contractor Starter Kit 21 Documents Included