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Mail ==AIA Document G706TM - 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: E IRC Fire Station #6 ARCHITECT: E 101 S . Highway AIA CONTRACT FOR: General Construction CONTRACTOR: E Vero Beach, FL 32963 SURETY: ❑ TO OWNER: (Name and address) CONTRACT DATED: 7/ 19/05 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 G707, Consent of Vero Beach, FL 3296 Surety, may be used for this purpose Indicate Attachment E Yes ❑ No BY: The following supporting documents should be attached (Si natur of auth 42i mative) hereto if required by the Owner: Phil Barth 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: ,5/I2- l04, Subcontractors and material and equipment suppliers, to the extent required by the Owner, / accompanied by a list thereof. T"�xJ ° Notary Public: Marion Tupek 3. Contractor' s Affidavit of Release of Liens My Commission Expires : July 21 , 2008 (AIA Document G706A). -NPO Marron H Tupelo My Commission DD339876 Voted' Expires July 21 , 2008 AIA Document G706w - 1994. Copyright © 1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This AIA' Document is protected by U S. Copyright Law and International Treaties. Unauthorized reproduction or distribution at this AIA` Document, or any port mr of it. may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent poi under the tow. This document was produced by AIA software at 15:00:47 on 05/12/2006 under Order No. 1000206383_1 which expires on 11/9/2006, and is not for resale. User Notes: (157295320)