JOB COMPLETION CERTIFICATE I (we), the project owners, hereby certify that all work, equipment and materials, covered by the contract
COMPLETION CERTIFICATE & FINAL PAYMENT CONDITIONAL LIEN RELEASE 1525 Cottage Grove Avenue Benicia, CA 94510 Owner’s Name:
800.820.5656
Owner’s Address
JOHN Q. CUSTOMER
[email protected] CA License No. 999999 (B) General Building
949 GRANT STREET, SUITE 4A
Owner’s City
Owner’s Zip Code
Owner’s Home Phone
Owner’s Work Phone
BENICIA
94510
707.747.4735
800.820.5656
Project Address
Project City
Project Zip Code
Project Phone
Date
747 BOEING STREET, SUITE 757
CONCORD
94510
510.015.1111
8-10-08
JOB COMPLETION CERTIFICATE I (we), the project owners, hereby certify that all work, equipment and materials, covered by the contract 8-10-08 between YOUR COMPANY NAME HERE and me (us) dated__________, has been satisfactorily completed and said work, equipment and materials has been inspected by me (us). NOTICE TO CUSTOMER DO NOT SIGN this certificate until you are satisfied that the work, equipment or materials, as specified in the contract, have been satisfactorily completed.
X____________________________________ COPYRIGHT 1996-2008 project owner/owner’s agentACT
date FORMS CONTRACTORS
X____________________________________ THIS IS FORM CLR project owner/owner’s agent
date
COMPLETION CERTIFICATE AND FINAL PAYMENT CONDITIONAL CONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT LIEN RELEASE John Q. Customer Upon receipt by the undersigned, of a check from ______________________________________, THIS IS ONE OF THE FORMS 4,868.40 in the sum of $_________________ made payable to YOUR COMPANY NAME HERE, INCLUDED IN THE FULL VERSION OF and when this check has been properly endorsed and hasACT been paid by the bank upon which it is CONTRACTORS FORMS ON DISK drawn, this document shall become effective to release any mechanic’s lien, stop or bond FOR notice, CALIFORNIA right the undersigned has on the job of ______________________________________, the project John Q. Customer GENERAL CONTRACTORS 747 Boeing St., Suite 757, Concord, CA 94556 owner, located at ______________________________________________________________, SOFTWARE the project address. This release covers the final payment to the undersigned for all labor, services, equipment or 1.800.820.5656 materials furnished on the job, except for disputed claims for additional work in the amount of 0.00 $______________. Before any recipient of this document relies on it, the party should verify evidence of payment to the undersigned.
30th September 08 Signed and delivered this _________ day of ____________________, 20____
YOUR COMPANY NAME HERE Company Name
Form CLR-C Copyright © 1996-2008 ACT Contractors Forms (800) 820-5656 www.calform.com
Signature of Contractor
