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low � TM 1994 <br /> Document G706 - <br /> Contractor's Affidavit of Payment of Debts and Claims <br /> PROJECT : (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: <br /> IRC Fire Station # 12 ARCHITECT: ❑ <br /> 3620 49" Street CONTRACT FOR: General Construction CONTRACTOR: ❑ <br /> Vero Beach , FL 32960 SURETY: ❑ <br /> TO OWNER: (Name and address) CONTRACT DATED: 9/ 16/08 OTHER: ❑ <br /> Indian River County <br /> 1840 25th Street <br /> Vero Beach , FL 32960 <br /> STATE OF: Florida <br /> COUNTY OF: Indian River <br /> The undersigned hereby certifies that, except as listed below, payment has been made in full and all obligations have <br /> otherwise been satisfied for all materials and equipment furnished, for all work, labor, and services performed, and <br /> for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with <br /> the performance of the Contract referenced above for which the Owner or Owner ' s property might in any way be <br /> held responsible or encumbered. <br /> EXCEPTIONS: <br /> SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) <br /> 1 . Consent of Surety to Final Payment. Whenever Barth Construction, Inc. <br /> Surety is involved, Consent of Surety is 1717 Indian River Blvd., Suite 202A <br /> required. AIA Document G707, Consent of Vero Beach, FL 32960 <br /> Surety, may be used for this purpose <br /> Indicate Attachment ® Yes ❑ No <br /> BY : <br /> The following supporting documents should be attached (Si nature o authorized representative) <br /> hereto if required by the Owner.- <br /> 1 . Contractor ' s Release or Waiver of Liens, ( ranted name and tine ) <br /> conditional upon receipt of final payment. <br /> 2. Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: <br /> Subcontractors and material and equipment <br /> suppliers, to the extent required by the Owner, <br /> accompanied by a list thereof. `�,, / ..JJ <br /> Notary Public /�� 1.J� <br /> 3, Contractor ' s Affidavit of Release of Liens My Commission Expires : 7' z i 112 <br /> (AIA Document G706A). <br /> MARION H. IUPEK <br /> k hill COMMISSION # DD 798038 <br /> ?; = EXPIRES: July 21 , 2012 <br /> Bonded Thni Notary Public Underwriters <br /> AIA Document G706TM — 1994. Copyright 0 1970 and 1994 by The American Institute of Architects. All rights reserved.. WARNING : This AIA` Document <br /> is <br /> protected by tl .S. Copyright Law slid international Treaties . Unauthorized reproduction or distribution of this AIA'' Document, or any Portion Of <br /> it. 1 <br /> is«ay rosrt9i ass seuern civil and crlrninal penalties, and will be prosecuted to the rnaxirnurn extent possible under the law. This document was <br /> produced by <br /> AIA software at 16: 11 :44 on 12/02/2009 under Order No. 1000396135_1 which expires on 04/22/2010 , and is not for resale. (793595443) <br /> User Notes: <br />