minutes board of supervisors, harrison county, mississippi minute

Document G706 lM - 1994
Contractor's Affidavit of Payment of Debts and Claims
PROJECT:OVameandaddres~
Biloxi Courthouse Annex
190 Lamuese Street
Biloxi, MS 39530
TO OWNER: OVame andaddress)
Harrison County Board of
Supervisors
P.O. Drawer CC
Gulfport, MS 39502
ARCHITECT'S PROJECT NUMBER:
08-006
CONTRACT FOR: General Construction
CONTRACT DATED: July 07, 2009
OWNER: I:2l
ARCHITECT: [2l
CONTRACTOR: 0
SURETY: 0
OTHER: 0
STATE OF: Mississippi
COUNTY OF: Neshoba
The undersigned hereby certifies that, except as listed below, payment has been made in full and all obligations have
otherwise been satisfied for all materials and equipment furnished, for all work, labor, and services performed, and for
all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the
performance ofthe Contract referenced above for which the Owner or Owner's property might in any way be held
responsible or encumbered.
EXCEPTIONS:
Pay Period Thru August 25 th 2009
SUPPORTING DOCUMENTS ATIACHED HERETO:
1. Consent ofSurety to Final Payment. Whenever
Surety is involved, Consent ofSurety is
required. AlA Document G707, Consent of
Surety, may be used for this purpose
Indicate Attachment 0 Yes ~ No
The following supporting documents should be attached
hereto ifrequired by the Owner:
1. Contractor's Release or Waiver ofLiens,
conditional upon receipt offinal payment.
CONTRACTOR: (Name andaddress)
Tyler Construction Group
203 W Beacon
Philadelphia MS 39350
BY:
Cherie Gamblin, Chairman
(Printed name and title)
2. Separate Releases or Waivers ofLiens from
Subcontractors and material and equipment
suppliers, to the extent required by the Owner,
accompanied by a list thereof.
3. Contractor's Affidavit ofRelease ofLiens (AlA
Document m06A).
AlA Document G706 -1994. Copyright C 1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING; This AlAf/) Document is
protected by U.S. Copyright Law and Internationill Treaties. Unauthorized reproduction or distribution of this AlA" Document, or any portion of It, may 1
result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AlA
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