CONTRACTORS AFFIDAVIT
STATE OF:
COUNTY OF:
Before me the undersigned a (Notary Public, Justice of the Peace,
Alderman) in and for said County and State Personally appeared (Individual, partner or duly)
who being duly sworn according to law deposes and says that the cost of all the Work, and outstanding claims and
indebtedness of whatever nature arising out of the performance of the Contract between City of Nashua, NH (Owner)
and (Contractor) of
(Contractor Address) dated for the construction of the Siphon Rehabilitation Project (Project Name)
and necessary appurtenant installations have been paid in full.
(Individual, Partner, or duly authorized representative of corporate contractor)
(Title)
Sworn to and subscribed before me
this day of ,20__
(Notary Public)
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