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<br />STATE OF <br /> <br />) <br /> <br />) <br /> <br />SS AFFIDAVIT AND WAIVER OF LIEN <br />SUBCONTRACTOR <br />OWNER'S PROJECT NO. <br /> <br />COUNTY OF <br /> <br />of <br />being first duly sworn, states as follows: <br /> <br />1) I am the <br /> <br />(title and/or position) of <br />(hereinafter referred to as <br />herein stated. <br /> <br />("ENGINEER") and am familiar with the facts <br /> <br />2) <br /> <br />ENGINEER has entered into an Agreement, dated <br /> <br />, <br />with (hereinafter <br />referred to as "OWNER"), to perform, or be responsible for performing certain <br />labor, and/or furnishing certain supplies, materials, equipment and/or other <br />facilities described in the Agreement designated above. <br /> <br />3) ENGINEER has paid in full for all such labor, supplies, materials, <br />equi pment and other fac;il i ti es furni shed by it, or by others for it, in <br />connection with the Project, and full payment has been made by all such <br />others for all labor, supplies, materials, equipment and other facilities <br />furnished by them. <br /> <br />4) ENGINEER has no 1 i en or cl a im ri ghts on account of any 1 abor, <br />supplies, materials, equipment or other facilities furnished by it, or by <br />others for it, in connection with the Project. <br /> <br />5) ENGINEER hereby waives all liens and claims against OWNER, its <br />premises, assets and property. <br /> <br />6) ENGINEER will hold OWNER harmless against any and all <br />liens, and claims and suits on liens, including all expenses, costs and <br />attorney fees associated therewith, arising out of any labor, supplies, <br />materials, equipment or other facilities furnished by it, or by others for <br />it, in connection with the Project. <br /> <br />Further affiant saith not. <br /> <br />SWORN TO before me and subscribed in my presence this <br />, 19 <br /> <br />day of <br /> <br />Notary <br /> <br />My commission expires: <br /> <br />- 13 - <br />