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PARTnITIM. 111111 IiIII[Ill I'll llâ–  <br />City of Pal -is <br />The undersigned hereby certifies that to the best of his knowledge, inforination and belief all <br />subcontractors,, all suppliers of material and equipment, and all performance of work, labor or <br />services who have or may have liens against any property of the, Owner arising in any manner out <br />of the performance; of the contract referenced above has been satisfied. Furthermore, the <br />undersigned certifies that he has paid in full or has otherwise satisfied all obligations for all <br />material and equipment furnished for all work, labor and services perfortned for the month of. <br />201 <br />The undersigned hereby certifies he has paid in full or has otherwise satisfied all known <br />indebtedness and clairns against the Owner for damages arising in any manner in connection with <br />the performance of the contract referenced above for which the Owner or his property might in <br />any way be held responsible, <br />Company Narne: <br />Address: <br />By: <br />Printed Name: <br />Title: <br />Subscribed and sworn to before me this day of 19 <br />Notary Public: <br />My Commission Expires. <br />CON], I RACT - 12 <br />