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    Contractor Completion Certificate and Final Payment Request: Please Turn Over

    Uploaded by

    Mohamed Ahmed
    This document is a contractor completion certificate and final payment request form for work completed as part of Vermont's Lead Based Paint Hazard Reduction Program. It includes information about the original contract amount, any change orders, payments received to date, and the balance due. The contractor certifies that all work has been properly completed and requests final payment. The property owner approves the work and authorizes final payment. Dust clearance lab results are reviewed and final program approval and payment are given.

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    © All Rights Reserved
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    Contractor Completion Certificate and Final Payment Request: Please Turn Over

    Uploaded by

    Mohamed Ahmed
    107 views2 pages
    This document is a contractor completion certificate and final payment request form for work completed as part of Vermont's Lead Based Paint Hazard Reduction Program. It includes information about the original contract amount, any change orders, payments received to date, and the balance due. The contractor certifies that all work has been properly completed and requests final payment. The property owner approves the work and authorizes final payment. Dust clearance lab results are reviewed and final program approval and payment are given.

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    ldfinalpay

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    This document is a contractor completion certificate and final payment request form for work completed as part of Vermont's Lead Based Paint Hazard Reduction Program. It includes information about the original contract amount, any change orders, payments received to date, and the balance due. The contractor certifies that all work has been properly completed and requests final payment. The property owner approves the work and authorizes final payment. Dust clearance lab results are reviewed and final program approval and payment are given.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    107 views2 pages

    Contractor Completion Certificate and Final Payment Request: Please Turn Over

    Uploaded by

    Mohamed Ahmed
    This document is a contractor completion certificate and final payment request form for work completed as part of Vermont's Lead Based Paint Hazard Reduction Program. It includes information about the original contract amount, any change orders, payments received to date, and the balance due. The contractor certifies that all work has been properly completed and requests final payment. The property owner approves the work and authorizes final payment. Dust clearance lab results are reviewed and final program approval and payment are given.

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    © All Rights Reserved
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    Vermont Housing and Conservation Board

    LEAD BASED PAINT HAZARD REDUCTION PROGRAM


    CONTRACTOR COMPLETION CERTIFICATE
    AND FINAL PAYMENT REQUEST

    Lead Program ProjectNumber: 68-_____-_____ Date: __________


    Property Owner Name: ________________________________________________
    Property Address: ________________________________________________
    ________________________________________________

    Name of Contractor: ________________________________________________


    Address of Contractor: ________________________________________________
    ________________________________________________

    Original Contract Amount $__________


    Change Orders
    #1 $__________
    #2 $__________
    Adjusted Contract Amount $__________
    Payments Received To Date
    #1 $__________
    #2 $__________
    BALANCE DUE ON CONTRACT $__________

    This is to request final payment for work performed under the Construction Contract dated
    ___/___/___ in the amount of $_________________. An invoice is attached.

    I certify that this request is made in conformance with the payment terms and
    conditions of the Construction Contract and that all work and materials have been
    provided and properly installed or executed. In accordance with the Contract and in
    connection with the final payment made thereunder, I hereby agree to discharge and hold
    the Owner and the VHCB Lead Hazard Reduction Program harmless from any and all
    claims (including all liens resulting therefrom) against the Owner and his/her property which
    the contractor or its assignee now has or ever had by virtue of or in connection with the
    work performed under said Contract. In consideration of said final payment, I hereby agree
    to discharge and hold the Owner and the VHCB Lead Hazard Reduction Program
    harmless from any and all claims (including all liens resulting therefrom) by all
    subcontractors, all suppliers of materials and equipment and performers of work, labor or
    services arising by virtue of, or in connection with the work performed under said Contract.
    I warrant all work and materials for one year from date hereof. In addition, I hereby
    assign to Owner all manufacturer warranties for materials provided under the Contract.

    _________________________________ __________
    Contractor Date

    Please Turn Over


    Vermont Housing and Conservation Board
    LEAD BASED PAINT HAZARD REDUCTION PROGRAM

    PROPERTY OWNER APPROVAL

    I have examined the work for which payment is requested and have found that all of the
    work called for in the Construction Contract has been completed in a satisfactory manner
    and in accordance with the Contract. I authorize a final payment of
    $____________________, the VHCB portion of which may be made directly to the
    contractor.

    __________________________________ __________
    Property Owner Date

    +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

    VERIFICATION OF DUST CLEARANCE

    Date of Dust Clearance ______/______/__________

    Lab Results reviewed and verified by:

    ________________________
    Signature

    _____________
    Date

    +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

    LEAD PROGRAM APPROVAL

    Final payment to the contractor is approved.

    ___________________________________ __________
    Signature Date

    I:\wp51\rebecca\forms\pay.frm (5/12/97)

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