FALSE AFFIDAVIT IS A CRIMINAL OFFENSE. EXECUTION BY OWNER (SEAL) State of County of (Affix Official/Notarial Seal) By: Signed and sworn to (or affirmed) before me this day by Printed or Typed Name/Title: [insert name(s) of principal(s)]. By: Date: Printed or Typed Name/Title: , Notary Public My Commission Expires: EXECUTION BY SOLE CONTRACTOR (THIS EXECUTION SECTION APPLIES ONLY IF UNDERSIGNED IS THE ONLY PERSON OR ENTITY CONTRACTING DIRECTLY WITH THE OWNER OF THE PROPERTY WITHIN THE 120-DAY LIEN PERIOD AND IS NOT THE OWNER OF THE PROPERTY. IF THIS CONTRACTOR IS SUBSTANTIALLY RELATED TO THE OWNER, CONSULT UNDERWRITING COUNSEL FOR TITLE INSURER/COMPANY PRIOR TO CLOSING.) (SEAL) State of County of (Affix Official/Notarial Seal) By: Signed and sworn to (or affirmed) before me this day by Printed or Typed Name/Title: [insert name(s) of principal(s)]. By: Date: Printed or Typed Name/Title: , Notary Public My Commission Expires: NOTE: ATTACH ADDITIONAL SIGNATURE PAGE(S) IF THERE ARE MULTIPLE CONTRACTORS AS DEFINED HEREIN. (ADDITIONAL SIGNATURE PAGE FOR CONTRACTORS WITH RESPECT TO PROPERTY: DESCRIBED AS OWNED BY NAME OF CONTRACTOR DATE LABOR, SERVICES OR MATERIALS FURNISHED SIGNATURE OF AUTHORIZED REPRESENTATIVE Surveyor/Engineer (SEAL) Architect (SEAL) General Contractor (SEAL) Clearing/Grading (SEAL) Foundation/Masonry (SEAL) Framing (SEAL) Roofing (SEAL) Electrical (SEAL) Plumbing (SEAL) Insulation (SEAL) Paving (SEAL) HVAC (SEAL) Sheet rock (SEAL) Cabinetry (SEAL) Finish Carpentry (SEAL) Painting (SEAL) Materials (SEAL) Landscaping (SEAL) Other: (SEAL) Other: (SEAL) Other: (SEAL) In accordance with the provisions of Paragraph 2 of this affidavit, each undersigned Contractor hereby waives and releases any lien, claim of lien or other interest whatsoever which such Contractor and anyone claiming by, through, or under such Contractor might have in the Property. NOTE: THE SIGNATURE BLOCKS PROVIDED ABOVE ARE NOT INTENDED TO BE COMPREHENSIVE. ALL CONTRACTORS WHO HAVE CONTRACTED OR DEALT WITH THE OWNER (as defined herein) MUST EXECUTE THIS AGREEMENT. ATTACH ADDITIONAL SIGNATURE PAGES AS NEEDED. OWNER/CONTRACTOR AFFIDAVIT, WAIVER OF LIENS AND INDEMNITY AGREEMENT (NO MECHANICS LIEN AGENT APPOINTED - CONSTRUCTION RECENTLY COMPLETED) (ADDITIONAL SIGNATURE PAGE FOR CONTRACTORS WITH RESPECT TO PROPERTY: DESCRIBED AS OWNED BY In accordance with the provisions of Paragraph 2 of this affidavit, each undersigned Contractor hereby waives and releases any lien, claim of lien or other interest whatsoever which such C...

FALSE AFFIDAVIT IS A CRIMINAL OFFENSE. EXECUTION (SEAL) State of County of (Affix Official/Notarial Seal) By: Signed and sworn to (or affirmed) before me this day by Printed or Typed Name/Title: [insert name(s) of principal(s)]. By: Date: Printed or Typed Name/Title: , Notary Public My Commission Expires: EXHIBIT A OWNER AFFIDAVIT AND INDEMNITY AGREEMENT (MLA – CONSTRUCTION COMPLETED, CONTEMPLATED OR UNDER WAY) WAIVER AND RELEASE OF LIENS (MLA APPOINTED) POTENTIAL LIEN CLAIMANT, , (hereinafter, “Potential Lien Claimant”) PROPERTY (Required): (Insert street address or brief description and/or attach a description as Exhibit A.)

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CRIMINAL OFFENCES 8.1 The Licensee acknowledges that the use of XXXXX’s Repertoire without the required licence constitutes an infringement of copyright and is an offence in terms of the Copyright Act 98 of 1978, punishable by a fine and/or imprisonment.
CRIMINAL/CIVIL SANCTIONS 1. Each officer or employee of any person to whom returns or return information is or may be disclosed will be notified in writing by such person that returns or return information disclosed to such officer or employee can be used only for a purpose and to the extent authorized herein, and that further disclosure of any such returns or return information for a purpose or to an extent unauthorized herein constitutes a felony punishable upon conviction by a fine of as much as $5,000 or imprisonment for as long as 5 years, or both, together with the costs of prosecution. Such person shall also notify each such officer and employee that any such unauthorized further disclosure of returns or return information may also result in an award of civil damages against the officer or employee in an amount not less than $1,000 with respect to each instance of unauthorized disclosure. These penalties are prescribed by IRC sections 7213 and 7431 and set forth at 26 CFR 301.6103(n)-1.
No Felony Criminal Convictions Contractor represents that neither Contractor nor any of its employees, agents, or representatives, including any subcontractors and employees, agents, or representative of such subcontractors, have been convicted of a felony criminal offense or that if such a conviction has occurred Contractor has fully advised System Agency in writing of the facts and circumstances surrounding the convictions.
XXXXXXXX ANTI-KICKBACK ACT (a) The Sub-Recipient hereby agrees that, unless exempt under Federal law, it will incorporate or cause to be incorporated into any contract for construction work, or modification thereof, the following clause:
Sanctions for Violation Any violation of the mandatory requirements of this WMBE Utilization provision shall be a material breach of contract for which the Contractor may be subject to damages and sanctions provided for by contract and by applicable law.
Program Fraud and False or Fraudulent Statements or Related Acts (A) The CONTRACTOR acknowledges that the provisions of the Program Fraud Civil Remedies Act of 1986, as amended, 31 U.S.C. § 3801 et seq . and U.S. DOT regulations, "Program Fraud Civil Remedies," 49 C.F.R. Part 31, apply to its actions pertaining to this Project. Upon execution of the underlying contract, the CONTRACTOR certifies or affirms the truthfulness and accuracy of any statement it has made, it makes, it may make, or causes to be made, pertaining to the underlying contract or the FTA assisted project for which this contract work is being performed. In addition to other penalties that may be applicable, the CONTRACTOR further acknowledges that if it makes, or causes to be made, a false, fictitious, or fraudulent claim, statement, submission, or certification, the Federal Government reserves the right to impose the penalties of the Program Fraud Civil Remedies Act of 1986 on the CONTRACTOR to the extent the Federal Government deems appropriate.
Civil Rights Compliance The parties to this Agreement are responsible for the following:
Offences 46.1. The Contractor must not commit or attempt to commit any offence:
Civil Rights X. Xxxxxxx agrees to comply with state and federal anti-discrimination laws, including:
ENVIRONMENT, SAFETY AND HEALTH PROTECTION (a) Seller shall perform this Agreement in a manner that ensures adequate protection for workers, the public, and the environment, and shall be accountable for actions of itself and its lower-tier subcontractors, agents and employees. Seller shall exercise a degree of care commensurate with the work and the associated hazards. Seller shall ensure that management of environment, safety and health (ES&H) functions and activities is an integral and visible part of Seller’s work planning and execution process. In the event that Xxxxxx fails to comply with this Agreement, Company may, without prejudice to any other legal or contractual rights, issue an order stopping all or any part of the work; thereafter a start order for resumption of work may be issued at Company’s discretion. Seller shall make no claim for an extension of time or for compensation or damages by reason of or in connection with such work stoppage. In addition, Company may require, in writing, that Seller remove from the work any employee the Company deems unsafe, incompetent, careless, or otherwise objectionable.

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