PROJECT CLOSE-OUT FORMS
CONTRACTOR'S FINAL LIEN WAIVER
(page 1 of 2)
OWNER'S CONTRACT NO:: ENGINEER’ PROJECT NO.:
AGREEMENT DATE:
CONTRACT TITLE:
To: (Owner)
APPLICATION FOR FINAL PAYMENT
The undersigned hereby certifies that the amount owed set forth below constitutes the entire
value of all work performed and services rendered by, through or under the undersigned with
respect to the project not heretofore paid for up to and including the period covered by the above
Application for Final Payment; that all work covered by such Application has been incorporated
into the project and title thereto has passed to the Owner free and clear of all liens, claims,
security, interests or encumbrances; and that no work covered by such Application has been
acquired subject to an agreement under which any interest therein or an encumbrance thereon is
retained by the seller or any other person. In consideration of payment of the requisition, the
undersigned hereby releases the Owner from all claims of lien which the undersigned has
regarding the Project.
The undersigned, in order to induce the Owner to pay the requisition, hereby represents that it has
paid or will pay from the proceeds of the requisition all sums due to those parties who have
performed work or provided materials to the undersigned in connection with the Project, and that
it will on request of the Owner provide written evidence of the discharge by the undersigned of
its obligations to such parties.
Executed under seal as of this day of , 20
Amount Owed to Contractor by Owner as Final Payment:
$ (total value of project including change orders)
Amount Unpaid From Previous Application for Payment:
$
9/07
