For Contractor. Applicable to Invoice No(s): ALL (If all, print “all”) Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Contractor and that this document was signed under oath personally and on behalf of Contractor. Notary Public My term expires (date): STATE OF COUNTY OF The undersigned, (“Subcontractor”) who has, under an agreement with the project known as (the “Project”), which is located in City of , County of , State of described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of $ , the Subcontractor waives and releases any and all liens or claims of liens it has upon the foregoing described property and excepting those rights and liens that Subcontractor might have in any retained amounts on account of materials, equipment, services and labor furnished by the undersigned to or on account of said Subcontractor for said building or premises. Exceptions as follows: (if no exception or “none” is entered above, undersigned shall be deemed not to have reserved any rights or liens.) Subcontractor agrees that this waiver and release form is in compliance with O.C.G.A. § 44-14-366(c). Applicable to Invoice(s) No. ALL Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Subcontractor and that this document was signed under oath personally and on behalf of Subcontractor. Notary Public My term expires (date): STATE OF COUNTY OF The undersigned, (“Subcontractor”) who has, under an agreement with the project known as (the “Project”), which is located in City of , County of , State of described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of U.S.$ , Subcontractor waives and releases any and all claims, demands, actions, causes of action or other rights at law, in contract, tort, equity or otherwise (except those concerning lien or bond rights which are separately waived pursuant to O.C.G.A. §44-140366 (1999) by the Subcontractor’s Claim Waiver and Release Upon Final, Conditional Payment form, which is executed concurrently with this form) that Subcontractor has or may have against (“Owner”) and Contractor (“Current Date”). Exceptions as follows: Subcontractor further represents that all employees, laborers, materialmen, Sub-Subcontractors and subconsultants employed by Subcontractor in connection with the Project have been paid for all work, materials, equipment, services, labor and any other items performed or provided through (date of last prior Invoice). Exceptions as follows: This Subcontractor’s Final Claim Waiver is freely and voluntarily given and Subcontractor acknowledges and represents that it has fully reviewed the terms and conditions of this Subcontractor’s Final Claim Waiver, that it is fully informed with respect to the legal effect of this Subcontractor’s Final Claim Waiver , that it has voluntarily chosen to accept the terms and conditions of this Subcontractor’s Final Claim Waiver in return for the payment recited above. Applicable to Invoice(s) No. ALL Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Subcontractor and that this document was signed under oath personally and on behalf of Subcontractor. Notary Public My term expires (date):
Appears in 1 contract
Sources: Construction Contract
For Contractor. Applicable to Invoice No(s): ALL (If all, print “all”) Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above(To be executed by Lien Wavier Subcontractors and Major Sub-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Contractor and that this document was signed under oath personally and on behalf of Contractor. Notary Public My term expires (date): subcontractors with their invoice for final payment) STATE OF COUNTY LOUISIANA COUNTY/PARISH OF CALCASIEU The undersigned, (“Subcontractor”) who ), has, under an agreement with ▇▇▇▇▇▇▇ Oil, Gas and Chemicals, Inc. (“Contractor”), furnished certain materials, equipment, services, and/or labor for the project known as engineering, procurement, construction, commissioning, start-up and testing of the Phase 4 Liquefaction Facility (the “Project”), which is located in City of , County of Calcasieu Parish, State of Louisiana, and is more particularly described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of $ , the Subcontractor waives and releases any and all liens or claims of liens it has upon the foregoing described property and excepting those rights and liens that Subcontractor might have in any retained amounts on account of materials, equipment, services and labor furnished by the undersigned to or on account of said Subcontractor for said building or premises. Exceptions as follows: (if no exception or “none” is entered above, undersigned shall be deemed not to have reserved any rights or liens.) Subcontractor agrees that this waiver and release form is in compliance with O.C.G.A. § 44-14-366(cProperty”). Applicable to Invoice(s) No. ALL Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Subcontractor and that this document was signed under oath personally and on behalf of Subcontractor. Notary Public My term expires (date): STATE OF COUNTY OF The undersigned, (“Subcontractor”) who has, under an agreement with the project known as (the “Project”), which is located in City of , County of , State of described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of U.S.$ , Subcontractor waives waives, relinquishes, remits and releases any and all privileges and liens or claims of privileges or liens against the Project and the Property, and all claims, demands, actions, causes of action or other rights at law, in contract, quantum meruit, unjust enrichment, tort, equity or otherwise (except those concerning lien or bond rights which are separately waived pursuant to O.C.G.A. §44-140366 (1999) by the Subcontractor’s Claim Waiver and Release Upon Final, Conditional Payment form, which is executed concurrently with this form) that Subcontractor has or may have against Driftwood LNG LLC (“Owner”) or Contractor, which Subcontractor has, may have had or may have in the future arising out of the agreement between Subcontractor and Contractor (“Current Date”)or the Project, whether or not known to Subcontractor at the time of the execution of this Subcontractor’s Final Conditional Lien and Claim Waiver. Exceptions as follows: Except for work and obligations that survive the termination or expiration of the agreement between Subcontractor further and Contractor, including warranties and correction of defective work, Subcontractor represents that all employeesof its obligations, laborerslegal, materialmenequitable, Sub-Subcontractors or otherwise, relating to or arising out of the agreement between Contractor and subconsultants employed by Subcontractor in connection with Subcontractor, the Project or sub-subcontracts have been paid for all work, materials, equipment, services, labor and any other items performed or provided through (date of last prior Invoice)fully satisfied. Exceptions as follows: This Subcontractor’s Final Conditional Lien and Claim Waiver is freely and voluntarily given and Subcontractor acknowledges and represents that it has fully reviewed the terms and conditions of this Subcontractor’s Final Conditional Lien and Claim Waiver, that it is fully informed with respect to the legal effect of this Subcontractor’s Final Conditional Lien and Claim Waiver Waiver, and that it has voluntarily chosen to accept the terms and conditions of this Subcontractor’s Final Conditional Lien and Claim Waiver in return for the payment recited above. Subcontractor understands, agrees and acknowledges that, upon payment, this document waives rights and is fully enforceable to extinguish all claims of Subcontractor as of the date of execution of this document by Subcontractor. This Subcontractor’s Final Conditional Lien and Claim Waiver has been executed by its duly authorized representative. Applicable to Invoice(s) NoInvoice No(s). ALL (If all, print “all”) Signed: (SEAL) By: Title: Date: On (To be executed by Lien Waiver Subcontractors and Major Sub-subcontractor as a condition of them receiving final payment) STATE OF LOUISIANA COUNTY/PARISH OF CALCASIEU The undersigned, (“Subcontractor”), has, under an agreement with Bechtel Oil, Gas and Chemicals, Inc. (“Contractor”), furnished certain materials, equipment, services, and/or labor for the engineering, procurement, construction, commissioning, start-up and testing of the Phase 4 Liquefaction Facility (the “Project”), which is located in Calcasieu Parish, State of Louisiana, and is more particularly described as follows: (the “Property”). Subcontractor has been paid in full for all work, materials, equipment, services and/or labor furnished by or on behalf of Subcontractor to or on account of Contractor for the Project, and Contractor hereby waives, relinquishes, remits and releases any and all privileges and liens or claims of privileges or liens against the Project and the Property, and all claims, demands, actions, causes of action or other rights at law, in contract, quantum meruit, unjust enrichment, tort, equity or otherwise against Driftwood LNG LLC (“Owner”) or Contractor, which Subcontractor has, may have had or may have in the future arising out of the agreement between Subcontractor and Contractor or the Project, whether or not known to Subcontractor at the time of the execution of this day Subcontractor’s Final Unconditional Lien and Claim Waiver. Except for work and obligations that survive the termination or expiration of the agreement between Subcontractor and Contractor, 20 including warranties and correction of defective work, before me appeared Subcontractor represents that all of its obligations, legal, equitable, or otherwise, relating to or arising out of the aboveagreement between Contractor and Subcontractor, the Project or sub-signedsubcontracts have been fully satisfied, known or identified including, but not limited to me personally, who, being first duly sworn, did say that s/he is the authorized representative payment to sub-subcontractors and employees of Subcontractor and payment of taxes. This Subcontractor’s Final Unconditional Lien and Claim Waiver is freely and voluntarily given and Subcontractor acknowledges and represents that it has fully reviewed the terms and conditions of this Subcontractor’s Final Unconditional Lien and Claim Waiver, and that it is fully informed with respect to the legal effect of this Subcontractor’s Final Unconditional Lien and Claim Waiver. Subcontractor understands, agrees and acknowledges that, upon execution of this document, this document was signed under oath personally waives rights unconditionally and on behalf is fully enforceable to extinguish all claims of Subcontractor as of the date of execution of this document by Subcontractor. Notary Public My term expires This Subcontractor’s Final Unconditional Lien and Claim Waiver has been executed by its duly authorized representative. Applicable to Invoice No(s). ALL (date):If all, print “all”) Signed: By: Title: Date: Attention: _____________ Re: RFSU Completion Certificate for the Lump Sum Turnkey Agreement for the Engineering, Procurement and Construction of the Driftwood LNG Phase [ ] Liquefaction Facility, dated as of [ ], 20[__] (the “Agreement”), by and between Driftwood LNG LLC (“Owner”) and Bechtel Oil, Gas and Chemicals, Inc. (“Contractor”) Pursuant to Section 11.2 of the Agreement, Contractor hereby certifies that it has completed all requirements under the Agreement for RFSU of Project [ ], including: (i) Contractor has completed all applicable Work in accordance with the requirements contained in the Agreement to ensure that the Project [ ] is ready for use to receive Feed Gas for liquefaction; and (ii) Contractor hereby delivers this RFSU Completion Certificate for the Project as required under Section 11.2 of the Agreement. Attached is supporting documentation which is reasonably required under the Agreement to establish that the requirements for this RFSU Completion Certificate under the Agreement have been met. Contractor certifies that it achieved all requirements under the Agreement for this RFSU Completion Certificate on ____________, 20___.
Appears in 1 contract
For Contractor. Applicable to Invoice invoice No(s): ALL (If all, print “all”) Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Contractor and that this document was signed under oath personally and on behalf of Contractor. Notary Public My term expires (date): STATE OF COUNTY [_____] COUNTY/PARISH OF [_____] The undersigned, (“Subcontractor”) who ), has, under an agreement with Black & ▇▇▇▇▇▇ Construction, Inc. (“Contractor”), furnished certain materials, equipment, services, and/or labor for the project known as design, engineering, scheduling, procurement, fabrication, manufacture, construction, erection, installation, pre-commissioning, commissioning, start-up, demonstration, and testing and warranty of the Facility (the “Project”), which is located in City of Wyalusing, County of Pennsylvania, State of and is more particularly described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) the “Property”). Upon receipt of the sum of $ U.S.$, the Subcontractor waives waives, relinquishes, remits and releases any and all privileges and liens or claims of privileges or liens it has upon against the foregoing described property Project and excepting those rights and liens that Subcontractor might have in any retained amounts on account of materialsthe Property, equipment, services and labor furnished by the undersigned to or on account of said Subcontractor for said building or premises. Exceptions as follows: (if no exception or “none” is entered above, undersigned shall be deemed not to have reserved any rights or liens.) Subcontractor agrees that this waiver and release form is in compliance with O.C.G.A. § 44-14-366(c). Applicable to Invoice(s) No. ALL Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Subcontractor and that this document was signed under oath personally and on behalf of Subcontractor. Notary Public My term expires (date): STATE OF COUNTY OF The undersigned, (“Subcontractor”) who has, under an agreement with the project known as (the “Project”), which is located in City of , County of , State of described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of U.S.$ , Subcontractor waives and releases any and all claims, demands, actions, causes of action or other rights at law, in contract, quantum meruit, unjust enrichment, tort, equity or otherwise (except those concerning lien or bond rights which are separately waived pursuant to O.C.G.A. §44-140366 (1999) by the Subcontractor’s Claim Waiver and Release Upon Final, Conditional Payment form, which is executed concurrently with this form) that Subcontractor has or may have against Bradford County Real Estate Partners LLC (“Owner”) or Contractor, which Subcontractor has, may have had or may have in the future arising out of the agreement between Subcontractor and Contractor (“Current Date”)or the Project, to the extent known to Subcontractor at the time of the execution of this Subcontractor’s Final Conditional Lien Waiver. Exceptions as follows: Except for work and obligations that survive the termination or expiration of the agreement between Subcontractor further and Contractor, including warranties and correction of defective work, Subcontractor represents that all employeesof its other obligations, laborerslegal, materialmenequitable, Sub-Subcontractors or otherwise, relating to or arising out of the agreement between Contractor and subconsultants employed by Subcontractor in connection with Subcontractor, the Project or sub-subcontracts have been paid for all work, materials, equipment, services, labor and any other items performed or provided through (date of last prior Invoice)fully satisfied. Exceptions as follows: This Subcontractor’s Final Claim Conditional Lien Waiver is freely and voluntarily given and Subcontractor acknowledges and represents that it has fully reviewed the terms and conditions of this Subcontractor’s Final Claim Conditional Lien Waiver, that it is fully informed with respect to the legal effect of this Subcontractor’s Final Claim Waiver Conditional Lien Waiver, and that it has voluntarily chosen to accept the terms and conditions of this Subcontractor’s Final Claim Conditional Lien Waiver in return for the payment recited above. Subcontractor understands, agrees and acknowledges that, upon payment, this document waives rights and is fully enforceable to extinguish all claims of Subcontractor as of the date of execution of this document by Subcontractor. This Subcontractor’s Final Conditional Lien Waiver has been executed by its duly authorized representative. Applicable to Invoice(s) Noinvoice No(s). ALL Signed: (SEALIf all, print “all”) By: Title: Date: On STATE OF [_____] COUNTY/PARISH OF [_____] The undersigned, (“Subcontractor”), has, under an agreement with Black & ▇▇▇▇▇▇ Construction, Inc. (“Contractor”), furnished certain materials, equipment, services, and/or labor for the design, engineering, scheduling, procurement, fabrication, manufacture, construction, erection, installation, pre-commissioning, commissioning, start-up, demonstration, and testing and warranty of the Facility (the “Project”), which is located in Wyalusing, Pennsylvania, and is more particularly described as follows: (the “Property”). Subcontractor has been paid in full for all work, materials, equipment, services and/or labor furnished by or on behalf of Subcontractor to or on account of Contractor for the Project, and Subcontractor hereby waives, relinquishes, remits and releases any and all privileges and liens or claims of privileges or liens against the Project and the Property, and all claims, demands, actions, causes of action or other rights at law, in contract, quantum meruit, unjust enrichment, tort, equity or otherwise against Bradford County Real Estate Partners LLC (“Owner”) or Contractor, which Subcontractor has, may have had or may have in the future arising out of the agreement between Subcontractor and Contractor or the Project, to the extent known to Subcontractor at the time of the execution of this day Subcontractor’s Final Unconditional Lien Waiver. Except for work and obligations that survive the termination or expiration of the agreement between Subcontractor and Contractor, 20 including warranties and correction of defective work, before me appeared Subcontractor represents that all of its other obligations, legal, equitable, or otherwise, relating to or arising out of the aboveagreement between Contractor and Subcontractor, the Project or sub-signedsubcontracts have been fully satisfied, known or identified including, but not limited to me personally, who, being first duly sworn, did say that s/he is the authorized representative payment to sub-subcontractors and employees of Subcontractor and payment of taxes. This Subcontractor’s Final Unconditional Lien Waiver is freely and voluntarily given and Subcontractor acknowledges and represents that it has fully reviewed the terms and conditions of this Subcontractor’s Final Unconditional Lien Waiver, and that it is fully informed with respect to the legal effect of this Subcontractor’s Final Unconditional Lien Waiver. Subcontractor understands, agrees and acknowledges that, upon execution of this document, this document was signed under oath personally waives rights unconditionally and on behalf is fully enforceable to extinguish all claims of Subcontractor as of the date of execution of this document by Subcontractor. Notary Public My term expires This Subcontractor’s Final Unconditional Lien Waiver has been executed by its duly authorized representative. Applicable to invoice No(s). (date):If all, print “all”) By: Title: Date: This guarantee and indemnity agreement (hereinafter referred to as the "Guarantee") effective on this the [9th] day of January, 2019, is entered into by BVH, Inc. (hereinafter referred to as "Guarantor"), in favor of Bradford County Real Estate Partners LLC (together with its successors and assigns hereunder and under the Agreement, the “Company”). In consideration of Company entering into (i) an Engineering, Procurement and Construction Agreement between Company and Guarantor’s wholly owned affiliate Black & ▇▇▇▇▇▇ Construction, Inc. (together with its successors and assigns under the Agreement, the “Contractor”) for the Facility and dated the 4th day of January, 2019 (as such agreement is amended, restated, supplemented or otherwise modified from time to time, the “Agreement”) and accepting this Guarantee in respect of such Agreement it is agreed as follows:
Appears in 1 contract
Sources: Engineering, Procurement and Construction Agreement (New Fortress Energy LLC)
For Contractor. Applicable to Invoice No(s): ALL (If all, print “all”) Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Contractor and that this document was signed under oath personally and on behalf of Contractor. Notary Public My term expires (date): STATE OF COUNTY LOUISIANA PARISH OF The undersigned, (“Subcontractor”) who ), has, under an agreement with ▇▇▇▇▇▇▇ Pipe Line Construction Company (“Contractor”), furnished certain materials, equipment, services, and/or labor for the project Project known as the Alternate Route 42” Single Line Option Creole Trail Pipeline - Segment 3A Project (the “Project”), which is located in City of , County of , State of and more particularly described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of $ , the Subcontractor waives and releases any and all liens or claims of liens it has upon the foregoing described property and excepting those rights and liens that Subcontractor might have in any retained amounts on account of materials, equipment, services and labor furnished by the undersigned to or on account of said Subcontractor for said building or premises. Exceptions as follows: (if no exception or “none” is entered above, undersigned shall be deemed not to have reserved any rights or liens.) Subcontractor agrees that this waiver and release form is in compliance with O.C.G.A. § 44-14-366(cProperty”). Applicable to Invoice(s) No. ALL Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Subcontractor and that this document was signed under oath personally and on behalf of Subcontractor. Notary Public My term expires (date): STATE OF COUNTY OF The undersigned, (“Subcontractor”) who has, under an agreement with the project known as (the “Project”), which is located in City of , County of , State of described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of U.S.$ , Subcontractor waives and releases any and all liens or claims of liens against the Project and the Property, all claims, demands, actions, causes of action or other rights at law, in contract, tort, equity or otherwise (except those concerning lien or bond rights which are separately waived pursuant to O.C.G.A. §44-140366 (1999) by the Subcontractor’s Claim Waiver and Release Upon Finalagainst Cheniere Creole Trail Pipeline, Conditional Payment form, which is executed concurrently with this form) that Subcontractor has or may have against L.P. (“Owner”) or Contractor, and Contractor (“Current Date”)any and all claims or rights against any labor and/or material bond, which Subcontractor has, may have had or may have in the future arising out of the agreement between Subcontractor and Contractor, the Project or the Property, whether or not known to Subcontractor at the time of the execution of this Subcontractor’s Final Lien and Claim Waiver. Exceptions as follows: Subcontractor further represents that all employeesof its obligations, laborerslegal, materialmenequitable, Subor otherwise, relating to or arising out of the agreement between Contractor and Subcontractor, the Project, the Property or sub-Subcontractors and subconsultants employed by Subcontractor in connection with the Project subcontracts have been paid fully satisfied (except for all workthat work and obligations that survive the termination or expiration of the agreement between Subcontractor and Contractor, materialsincluding warranties and correction of defective services), equipmentincluding, services, labor but not limited to payment to sub-subcontractors and any other items performed or provided through (date employees of last prior Invoice)Subcontractor and payment of taxes. Exceptions as follows: This Subcontractor’s Final Lien and Claim Waiver is freely and voluntarily given and Subcontractor acknowledges and represents that it has fully reviewed the terms and conditions of this Subcontractor’s Final Lien and Claim Waiver, that it is fully informed with respect to the legal effect of this Subcontractor’s Final Lien and Claim Waiver Waiver, and that it has voluntarily chosen to accept the terms and conditions of this Subcontractor’s Final Lien and Claim Waiver in return for the payment recited above. Subcontractor understands, agrees and acknowledges that, upon payment, this document waives rights unconditionally and is fully enforceable to extinguish all claims of Subcontractor as of the date of execution of this document by Subcontractor. Applicable to Invoice(s) NoInvoice No(s). ALL (If all, print “all”) Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Subcontractor and that this document was signed under oath personally and on behalf of Subcontractor. Notary Public My term expires (date):
Appears in 1 contract
For Contractor. Applicable to Invoice No(s): ALL (If all, print “all”) Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Contractor and that this document was signed under oath personally and on behalf of Contractor. Notary Public My term expires (date): STATE OF COUNTY LOUISIANA COUNTY/PARISH OF CAMERON The undersigned, (“Subcontractor”) who ), has, under an agreement with ▇▇▇▇▇▇▇ Oil, Gas and Chemicals, Inc. (“Contractor”), furnished certain materials, equipment, services, and/or labor for the project known as engineering, procurement and construction of the Stage 2 Liquefaction Facility and certain modifications and improvements to the Existing Facility and Stage 1 Liquefaction Facility, and the commissioning, start-up and testing of the Stage 2 Liquefaction Facility (collectively, the “Project”), which is located in City of , County of Cameron Parish, State of Louisiana, and is more particularly described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of $ , the Subcontractor waives and releases any and all liens or claims of liens it has upon the foregoing described property and excepting those rights and liens that Subcontractor might have in any retained amounts on account of materials, equipment, services and labor furnished by the undersigned to or on account of said Subcontractor for said building or premises. Exceptions as follows: (if no exception or “none” is entered above, undersigned shall be deemed not to have reserved any rights or liens.) Subcontractor agrees that this waiver and release form is in compliance with O.C.G.A. § 44-14-366(cProperty”). Applicable to Invoice(s) No. ALL Signed: (SEAL) By: Title: Date: On this day of , 20 , before me appeared the above-signed, known or identified to me personally, who, being first duly sworn, did say that s/he is the authorized representative of Subcontractor and that this document was signed under oath personally and on behalf of Subcontractor. Notary Public My term expires (date): STATE OF COUNTY OF The undersigned, (“Subcontractor”) who has, under an agreement with the project known as (the “Project”), which is located in City of , County of , State of described in more detail as follows: (DESCRIBE THE PROPERTY UPON WHICH THE IMPROVEMENTS WERE MADE BY USING EITHER A METES AND BOUNDS DESCRIPTION, THE LAND LOT DISTRICT, BLOCK AND LOT NUMBER, OR STREET ADDRESS OF THE PROJECT.) Upon receipt of the sum of U.S.$ , Subcontractor waives waives, relinquishes, remits and releases any and all privileges and liens or claims of privileges or liens against the Project and the Property, and all claims, demands, actions, causes of action or other rights at law, in contract, quantum meruit, unjust enrichment, tort, equity or otherwise (except those concerning lien or bond rights which are separately waived pursuant to O.C.G.A. §44-140366 (1999) by the Subcontractor’s Claim Waiver and Release Upon Finalagainst Sabine Pass Liquefaction, Conditional Payment form, which is executed concurrently with this form) that Subcontractor has or may have against LLC (“Owner”) or Contractor, which Subcontractor has, may have had or may have in the future arising out of the agreement between Subcontractor and Contractor (“Current Date”)or the Project, whether or not known to Subcontractor at the time of the execution of this Subcontractor’s Final Conditional Lien and Claim Waiver. Exceptions as follows: Except for work and obligations that survive the termination or expiration of the agreement between Subcontractor further and Contractor, including warranties and correction of defective work, Subcontractor represents that all employeesof its obligations, laborerslegal, materialmenequitable, Sub-Subcontractors or otherwise, relating to or arising out of the agreement between Contractor and subconsultants employed by Subcontractor in connection with Subcontractor, the Project or sub-subcontracts have been paid for all work, materials, equipment, services, labor and any other items performed or provided through (date of last prior Invoice)fully satisfied. Exceptions as follows: This Subcontractor’s Final Conditional Lien and Claim Waiver is freely and voluntarily given and Subcontractor acknowledges and represents that it has fully reviewed the terms and conditions of this Subcontractor’s Final Conditional Lien and Claim Waiver, that it is fully informed with respect to the legal effect of this Subcontractor’s Final Conditional Lien and Claim Waiver Waiver, and that it has voluntarily chosen to accept the terms and conditions of this Subcontractor’s Final Conditional Lien and Claim Waiver in return for the payment recited above. Subcontractor understands, agrees and acknowledges that, upon payment, this document waives rights and is fully enforceable to extinguish all claims of Subcontractor as of the date of execution of this document by Subcontractor. This Subcontractor’s Final Conditional Lien and Claim Waiver has been executed by its duly authorized representative. Applicable to Invoice(s) NoInvoice No(s). ALL (If all, print “all”) Signed: (SEAL) By: Title: Date: On STATE OF LOUISIANA COUNTY/PARISH OF CAMERON The undersigned, (“Subcontractor”), has, under an agreement with ▇▇▇▇▇▇▇ Oil, Gas and Chemicals, Inc. (“Contractor”), furnished certain materials, equipment, services, and/or labor for the engineering, procurement and construction of the Stage 2 Liquefaction Facility and certain modifications and improvements to the Existing Facility and Stage 1 Liquefaction Facility, and the commissioning, start-up and testing of the Stage 2 Liquefaction Facility (collectively, the “Project”), which is located in Cameron Parish, State of Louisiana, and is more particularly described as follows: (the “Property”). Subcontractor has been paid in full for all work, materials, equipment, services and/or labor furnished by or on behalf of Subcontractor to or on account of Contractor for the Project, and Contractor hereby waives, relinquishes, remits and releases any and all privileges and liens or claims of privileges or liens against the Project and the Property, and all claims, demands, actions, causes of action or other rights at law, in contract, quantum meruit, unjust enrichment, tort, equity or otherwise against Sabine Pass Liquefaction, LLC (“Owner”) or Contractor, which Subcontractor has, may have had or may have in the future arising out of the agreement between Subcontractor and Contractor or the Project, whether or not known to Subcontractor at the time of the execution of this day Subcontractor’s Final Unconditional Lien and Claim Waiver. Except for work and obligations that survive the termination or expiration of the agreement between Subcontractor and Contractor, 20 including warranties and correction of defective work, before me appeared Subcontractor represents that all of its obligations, legal, equitable, or otherwise, relating to or arising out of the aboveagreement between Contractor and Subcontractor, the Project or sub-signedsubcontracts have been fully satisfied, known or identified including, but not limited to me personally, who, being first duly sworn, did say that s/he is the authorized representative payment to sub-subcontractors and employees of Subcontractor and payment of taxes. This Subcontractor’s Final Unconditional Lien and Claim Waiver is freely and voluntarily given and Subcontractor acknowledges and represents that it has fully reviewed the terms and conditions of this Subcontractor’s Final Unconditional Lien and Claim Waiver, and that it is fully informed with respect to the legal effect of this Subcontractor’s Final Unconditional Lien and Claim Waiver. Subcontractor understands, agrees and acknowledges that, upon execution of this document, this document was signed under oath personally waives rights unconditionally and on behalf is fully enforceable to extinguish all claims of Subcontractor as of the date of execution of this document by Subcontractor. Notary Public My term expires This Subcontractor’s Final Unconditional Lien and Claim Waiver has been executed by its duly authorized representative. Applicable to Invoice No(s). ALL (date):If all, print “all”) Signed: By: Title: Date: Sabine Pass Liquefaction, LLC 70▇ ▇▇▇▇▇ ▇▇▇▇▇▇, Suite 800 Houston, Texas 77002 Attention: Re: RFSU Completion Certificate for Subproject — Lump Sum Turnkey Agreement for the Engineering, Procurement and Construction of the Sabine Pass LNG Stage 2 Liquefaction Facility, dated as of [ ], 20[ ] (the “Agreement”), by and between Sabine Pass Liquefaction, LLC (“Owner”) and ▇▇▇▇▇▇▇ Oil, Gas and Chemicals, Inc. (“Contractor”) Pursuant to Section 11.1 of the Agreement, Contractor hereby certifies that it has completed all requirements under the Agreement for RFSU of Subproject , including: (i) Contractor has completed all applicable Work in accordance with the requirements contained in the Agreement to ensure that such Subproject is ready for use to receive Natural Gas; and (ii) Contractor hereby delivers this RFSU Completion Certificate for such Subproject as required under Section 11.1 of the Agreement. Attached is supporting documentation which is reasonably required under the Agreement to establish that the requirements for this RFSU Completion Certificate under the Agreement have been met. Contractor certifies that it achieved all requirements under the Agreement for this RFSU Completion Certificate on , 20 .
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Sources: Lump Sum Turnkey Agreement (Cheniere Energy Partners, L.P.)