HomeMy WebLinkAboutNational Water Services LLC/UTL/$848,848/Well 29By Sergey Grechukhin at 11:02 am, Jan 21, 2025
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
NOT PRESENT
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Well 29 City of Carmel, Indiana
Contractor’s Affidavit and Waiver of Liens and Claims
EXHIBIT D
CONTRACTOR’S AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS
(__) FINAL (__) PARTIAL (__) PAYMENT TO FOLLOW
OWNER: City of Carmel, Indiana Department
of Public Works.
PROJECT:
CONTRACTOR:CONTRACT DATE:
________________________________ being duly sworn states that he or she is the ___________________ of
CONTRACTOR, which was awarded Contract No. __________________ with the OWNER in accordance with the
contract terms and conditions to install and/or furnish certain materials and labor as follows:
__________________________________________________________________________(“Work”) for the Project,
DOES HEREBY STATE, WARRANT AND REPRESENT ON BEHALF OF THE CONTRACTOR the following:
PARTIAL WAIVER That the balance due from OWNER is the sum of ($__________________________).
( ) Receipt of which is hereby acknowledged; or
( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIENS
AND CLAIMS and which is given to and for said amount effective upon receipt of such payment.
FINAL WAIVER That the final balance due from OWNER is the sum of ($________________________).
( ) Receipt of which is hereby acknowledged; or
( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIENS
AND CLAIMS which is given to and for said amount effective upon receipt of such payment.
THEREFORE, through the date hereof, Contractor waives and releases the Owner and Project of all liens or claims,
including, but not limited to, claims for materials, equipment, labor, superintendence and other services or Work
performed or furnished by Contractor and further affirms that no other party has any claim or right to lien on account of
any materials, equipment, labor, superintendence and other services or Work performed or furnished to or for
Contractor for the Project. Contractor agrees to indemnify, defend and hold the Owner and Project harmless, including
costs and attorneys’ fees, from and against any and all claims or liens for any subcontractors, materials, supplies,
equipment or labor furnished for, in connection with or incorporated into the Project by, through or under Contractor
through the date hereof. This Affidavit and Waiver of Liens is given to induce Owner to pay the amount indicated
above. Contractor represents that all employees, subcontractors or materialmen have been paid or will be paid from
these funds.
That through the date hereof, all Affidavits and Waiver of Liens and Claims are true, correct and unconditional and that
there is no claim either legal or equitable to defeat the validity of said Affidavits and Waiver of Liens and Claims. That
the following are the names of all parties who have furnished material or labor, or both, for said Work and all parties
having contracts or subcontracts for specific portions of said Work or for material used in the construction thereof and
the amount due or to become due to each, and that the items mentioned include all labor and material required to
complete said Work according to Project plans and specifications:
1 2 3 4 5 6 7
CONTRACTOR TYPE OF
WORK
AMOUNT OF
CONTRACT
TOTAL
RETAINED
NET
PREVIOUSLY
PAID
NET
AMOUNT
THIS
PAYMENT
BALANCE
TO
BECOME
DUE
TOTAL
AMOUNT OF ORIGINAL CONTRACT
EXTRAS TO CONTRACT
TOTAL CONTRACT & EXTRAS
CREDITS TO CONTRACT
ADJUSTED TOTAL CONTRACT
WORK COMPLETED TO DATE
LESS RETAINAGE
NET AMOUNT EARNED
NET PREVIOUSLY PAID
NET AMOUNT OF THIS PAYMENT
BALANCE TO BECOME DUE
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Well 29 City of Carmel, Indiana
Contractor’s Affidavit and Waiver of Liens and Claims
This instrument has been executed as of the __________ day of __________________, 20____.
CONTRACTOR:___________________________
By:
Name:
Title:
STATE OF INDIANA
COUNTY
OF
Sworn to and subscribed before me the undersigned authority on this _____________ day of
______________________, 20____.
Notary Public, State
of
Printed Name of
Notary
[ SEAL]
My Commission Expires:
____________________
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Well 29 City of Carmel, Indiana
Subcontractor’s Affidavit and Waiver of Liens and Claims
EXHIBIT E
SUBCONTRACTOR AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS
(__) FINAL (__) PARTIAL (__) PAYMENT TO FOLLOW
OWNER: City of Carmel, Indiana Department
of Public Works.
PROJECT:
SUBCONTRACTOR:CONTRACT DATE:
________________________________ being duly sworn states that he or she is the ___________________ of
SUBCONTRACTOR, which entered into a contract in writing with _______________ (“CONTRACTOR”) who was
awarded Contract No. __________________ with the OWNER in accordance with the contract terms and conditions
to install and/or furnish certain materials and labor as follows:
__________________________________________________________________________(“Work”) for the Project,
DOES HEREBY STATE, WARRANT AND REPRESENT ON BEHALF OF THE SUBCONTRACTOR the following:
PARTIAL WAIVER That the balance due from CONTRACTOR is the sum of ($_____________________).
( ) Receipt of which is hereby acknowledged; or
( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIENS
AND CLAIMS and which is given to and for said amount effective upon receipt of such payment.
FINAL WAIVER That the final balance due from CONTRACTOR is the sum of ($____________________).
( ) Receipt of which is hereby acknowledged; or
( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIENS
AND CLAIMS which is given to and for said amount effective upon receipt of such payment.
THEREFORE, through the date hereof, Subcontractor waives and releases the Owner, Contractor and Project of all
liens or claims, including, but not limited to, claims for materials, equipment, labor, superintendence and other services
or Work performed or furnished by Subcontractor and further affirms that no other party has any claim or right to lien
on account of any materials, equipment, labor, superintendence and other services or Work performed or furnished to
or for Subcontractor for the Project. Subcontractor agrees to indemnify, defend and hold the Owner, Contractor and
Project harmless, including costs and attorneys’ fees, from and against any and all claims or liens for any sub-
subcontractors, materials, supplies, equipment or labor furnished for, in connection with or incorporated into the Project
by, through or under Subcontractor through the date hereof. This Affidavit and Waiver of Liens is given to induce
Contractor to pay the amount indicated above. Subcontractor represents that all employees, subcontractors or
materialmen have been paid or will be paid from these funds.
That through the date hereof, all Affidavits and Waiver of Liens and Claims are true, correct and unconditional and that
there is no claim either legal or equitable to defeat the validity of said Affidavits and Waiver of Liens and Claims. That
the following are the names of all parties who have furnished material or labor, or both, for said Work and all parties
having contracts or subcontracts for specific portions of said Work or for material used in the construction thereof and
the amount due or to become due to each, and that the items mentioned include all labor and material required to
complete said Work according to Project plans and specifications:
1 2 3 4 5 6 7
SUBCONTRACTOR TYPE OF
WORK
AMOUNT
OF
CONTRACT
TOTAL
RETAINED
NET
PREVIOUSLY
PAID
NET
AMOUNT
THIS
PAYMENT
BALANCE
TO
BECOME
DUE
TOTAL
AMOUNT OF ORIGINAL CONTRACT
EXTRAS TO CONTRACT
TOTAL CONTRACT & EXTRAS
CREDITS TO CONTRACT
ADJUSTED TOTAL CONTRACT
WORK COMPLETED TO DATE
LESS RETAINAGE
NET AMOUNT EARNED
NET PREVIOUSLY PAID
NET AMOUNT OF THIS PAYMENT
BALANCE TO BECOME DUE
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Well 29 City of Carmel, Indiana
Subcontractor’s Affidavit and Waiver of Liens and Claims
This instrument has been executed as of the __________ day of __________________, 20____.
CONTRACTOR:___________________________
By:
Name:
Title:
STATE OF INDIANA
COUNTY
OF
Sworn to and subscribed before me the undersigned authority on this _____________ day of
______________________, 20____.
Notary Public, State
of
Printed Name of
Notary
[ SEAL]
My Commission Expires:
____________________
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74
Docusign Envelope ID: 239618E8-F7E6-4969-8BC1-06C7CCFB0F74