WA9701-CN060724Affidavit of Bills Paid
OWNER: City of Coppell
CONTRACTOR: J T Dersner, Inc.
PROJECT: 16" Water Line Denton Tap Rd
I, Teresa Childers, President of J T Dersner, Inc. affirm that all bills have been paid
for supplies and/or labor furnished for the project on Denton Tap Rd.
Teresa Childers
Date
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IE: JENNIFER R. MARX
Notary Public, State of Texas
My Commission Expires
October 20, 2007
RECEIPT OF FINAL PAYABLE WAIVER
CONTRACTOR: J T Dersner, Inc.
PROJECT ADDRESS: Denton Tap, City of Coppell
AMOUNT: $7,359.70
WHEREAS, the undersigned, hereinafter called "Sub- Contractor" , has performed
labor and/or furnished materials or done both pursuant to the undersigned's
contract/purchase order with the above - mentioned Contractor, in connection with
improvements made to the above - mentioned address.
WHEREAS, as a result the above amount is due and payable to Sub - Contractor
from Contractor for the period shown and, Sub - Contractor has been requested to
acknowledge release, waive any liens of claims Sub - Contractor may have or assert
against Contractor or such improvements and real property that have arisen by
virtue of Subcontractor in connection with such construction.
NOW THEREFORE, based on a payment of sums due within thirty day period
Sub - Contractor hereby waives, relinquishes and releases its liens, claims, rights and
charges of every nature whatsoever which have arisen by virtue of such labor
and/or materials having been performed or furnished by Sub - Contractor, including
any and all mechanic's or material man's liens to the extent such monies owed have
been paid; provided, however, such waiver, relinquishment and release shall not
affect Contractor' s lien claims and rights with respect to sums which are now due
and payable by Contractor, including sums retained by Contractor as may be
required by law or by agreement between Sub - Contractor and Contractor.
Executed this
day of , 2006
Sub- o tr ctor: S g Road Boring, Inc.
B,
Title V C!L ►�
State of Tex
County of
Subscribed and Sworn to before me this day o ,2006 to
certify which, witness my hand and seal of offs e.
���� "`' JENNIFER R. MARX
Notary Public, State of Texas
My Commission Expires
October 20, 2007
N ational P.O. BOX 8328,76714-8328 TELEPHONE 254 - 772 -5355
AMERICAN PLAZA FACSIMILE 254 - 772 -5716
Wate 200 WEST HWY 6, SUITE 620
WACO,TX 76712
JUL 18 1006
TO WHOM IT MAY CONCERN
RE: DERSNERJT
DENTON TAP RD
On July 14, 2006, National Waterworks filed notice of non - payment on DERSNERJT for the DENTON
TAP RD project. Please be advised that those invoices have been paid and our notice is withdrawn. We
regret any inconvenience this action may have caused.
Note! This retraction is in effect when the check has been properly endorsed and has been paid by the bank
upon which it is drawn.
Thank you for your understanding.
Sincerely,
4 DeY Z �
Credit Manager
CC:
CITY OF COPPELL
255 PARKWAY BLVD
COPPELL, TX
75019
J.T. DERSNER, INC.
2101 E SHADY GROVE RD
IRVING, TX
75060 6429
WASHINTON INTERNATIONAL INS CO
1200 ARLINGTON HEIGHTS RD #400
ATTN: BOND CLAIMS
ITASCA, IL
60143
ReLgls
"Local Service, Nationwide"
www nationalwaterworks.corn
T H E C I T Y - O F
P.O. COPPELL Coppell, TX 75019
255 Parkway Blvd
Phone: (972)304-3679
Fax: (972) 304 -3570
X A s 1 $
ENGINEERING DEPARTMENT
FAX COVER SHEET
To: Teresa Childers From: Keith Marvin
Fax: 972/421 -0934 Date: July 26, 2006
Phone: 972/421 -0930 Pages: 2 (including cover sheet)
Re: Affidavit CC:
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ As Requested
Comments:
IF YOU DO NOT RECEIVE ALL OF THE PAGES PLEASE CALL (9 72) 304 -3679
"City of Coppell Engineering —Excellence By Design"
CONTRACTOR'S AFFIDAVIT OF FINAL PAYMENT AND RELEASE
THE STATE OF TEXAS §
COUNTY OF §
BEFORE ME, the undersigned authority, on this day personally appeared
who, after being by me duly sworn, deposes and says that he is
(corporation, partnership, trade name) of
State of Texas (the "Contractor "), which said Contractor was awarded the contract dated the
20 , for the construction of
at
(the "Work "), for a total consideration of
a
County,
day of
Dollars to be paid to the said Contractor (the "Contractor "), and the Affiant has full power of authority to make this
affidavit.
That (the "Owner ") has approved the final estimate on
said Work, and that the said Contractor has fully satisfied and paid any and all claims that may be covered by Chapter
53 of the Texas Property Code, and Article 5160 of the Revised Civil Statutes of the State of Texas, or any other
applicable statutes or charter provisions, and that all just bills for labor and materials have been paid and discharged by
said Contractor insofar as they pertain to the Work in question.
That in addition to any funds which may have been previously paid by the Owner, the Contractor hereby
accepts the amount of Dollars as FULL AND FINAL PAYMENT
under the aforementioned contract, and hereby waives and releases any right Affiant and /or the Contractor may have to
pursue claims of any nature against the Owner arising out of or in any manner connected with the performance of the
Work and/or the Contract, including but not limited to claims of third parties that supplied material and /or labor for the
Work for or through the Contractor ( "Subcontractors "), as well as claims for delay, additional compensation or for
recovery of liquidated damages which may have been withheld by the Owner. The Contractor shall defend, hold
harmless and indemnify the Owner from any such claims of such Subcontractors. The Contractor further releases the
Owner from any claim or liability arising from any act or neglect of the Owner related to or connected with the
Contract. This affidavit is given pursuant to the final payment provisions of the Contract, and shall not be deemed to
alter or modify the terms and provisions of said Contract.
SUBSCRIBED AND SWORN TO BEFORE ME, this the
By
(Affiant)
(Printed Name)
_day of
A.D. 20
(Notary Public, in and for the State of Texas)
(Printed Name of Notary)
My Commission Expires
( "Affiant "),
MESSAGE C[lk]FTC]h1/l7-?[lk]
07/26/2006 08:55
ID=CITY OF COPPELL ENGR. DEPT'
DATE TIME S.R-TIME DISTANT STATION ID MODE PAGES RESULT
07/26 08:54 00 9724210934 CALLING 02 O� 0000