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T I Document G706TM - 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: ❑ IRC Fire Station #5 ARCHITECT: ❑ 6585 U.S. Highway I CONTRACT FOR: General Construction CONTRACTOR: ❑ Vero Beach, FL 32967 SURETY: ❑ TO OWNER: (Name and address) CONTRACT DATED: 5/24/06 OTHER: ❑ Indian River County 1840 25th Street Vero Beach, FL 32960 STATE OF: Florida COUNTY OF: Indian River 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 of the Contract referenced above for which the Owner or Owner' s property might in any way be held responsible or encumbered. EXCEPTIONS: SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1 . Consent of Surety to Final Payment. Whenever Barth Construction, Inc. Surety is involved, Consent of Surety is 1717 Indian River Blvd.. Suite 202A required. AIA Document 6707, Consent of Vero Beach, FL 32960 Surety, may be used for this purpose Indicate Attachment ® Yes ❑ No , BY: An The following supporting documents should be attachedignature of authorized representative) hereto if required by the Owner: 1 . Contractor' s Release or Waiver of Liens, (Printed name and title) conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: Subcontractors and material and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. Notary Public: 3. Contractor' s Affidavit of Release of Liens My Commission Expires: (AIA Document G706A). AIA Document G706re - 1994. Copyright m 1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING : This Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, 1 may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 08:54:20 on 10/17/2007 under Order No. 1000304448_1 which expires on 5/29/2008, and is not for resale. User Notes: (3821035828)