HomeMy WebLinkAboutInv# APP NO. 5 - Kailas Corp. - 12/31/2022 (2)WAIVER AND PARTIAL RELEASE OF LIEN
The undersigned lienor, in consideration of the progress payment in the amount of
$-145,901.00_ hereby waives and releases its lien and right to claim lien of labor,
services or materials fumished through 11/EIOI2O22" to Gitv of Dania Beach
(Ovned.- on the proiecf SW 37 Tenace Stonrruater lmprcvement at the following
property:
Project: SW 37TH IERR IIfiPROVEMENIS yrC OF 5720 SW 37TH TERRACE
DANIA BEACH FL 33312
The waiver and release does not cover any retention of labor, services and/or materials
fumished afterthe date specified-
Dated on (\ ----,wrtn-cr( \b 20ZL.
Lienofs name:
Address: P.O. Box 552098
Davie Fr33355
By:JORGE PAZ. PRESIDENT
STATE OF FLORIDA
COUNTY OF
I hereby acknowledge that the statements contained in the foregoing release of lien are
true and correct-
Sworn to and subscribed before me this lb day of k-Errthezt , 2O-Z
Signature-
Printed Name:
,Vote-'Thb is a sBtutory form prescribed by section 713.20, Florida Statutes (1996). Eftctive October 1{, 1996; a person may
nd requirc a lenor to fumish a waiver or rdease of fien that is ditrerent frorn the stafutory form.
CIAUDIA gERI{At
Notary Publlc
State of Florlda
Comm#HH200039
Expires tAfinOZSffi
WAIVER AND PARTIAL RELEASE OF LIEN
The undersigned lienor, in consideration of the progress payment in the amount of $0.00
hereby waives and releases its lien and right to claim lien of labor, services or
materials furnished through 11/30/22, to KAILAS CORP (Prime Contractors) and City
of Dania Beach (Owner).. on the project SW 37 Terrace Stormwater Improvementat the
following property:
Project: SW 37TH TERR IMPROVEMENTS VIC OF 5720 SW 37TH TERRACE
DANIA BEACH FL 33312
The waiver and release does not cover any retention of labor, services and/or materials
furnished after the date specified.
Dated on ________________________, 20_____.
Lienor’s name: _______________________
Address: ____________________________
____________________________
____________________________
By: _______________________________
STATE OF FLORIDA
COUNTY OF
I hereby acknowledge that the statements contained in the foregoing release of lien are
true and correct.
Sworn to and subscribed before me this _____ day of _______________, 20___.
Signature: _________________________________
Printed Name: ______________________________
Note: This is a statutory form prescribed by section 713.20, Florida Statutes (1996). Effective October 1st, 1996; a person may
not require a lienor to furnish a waiver or release of lien that is different from the statutory form.
JANUARY 16 23
Ferguson Enterprises
PO BOX 100286ATLANTA, GA 30384-0286
*SIGNATURE AUTHORIZATION INCLUDED. FLORIDA STATE STATUTE 713.20 DOES NOT REQUIRE NOTARIZATION
FLORIDA STATE STATUTE 713.20 DOES NOT REQUIRE NOTARIZATION
WAIVER AND PARTIAL RELEASE OF LIEN
The undersigned lienor, in consideration of the progress payment in the amount of $0.00
hereby waives and releases its lien and right to claim lien of labor, services or
materials furnished through 11/30/22, to KAILAS CORP (Prime Contractors) and City
of Dania Beach (Owner).. on the project SW 37 Terrace Stormwater Improvementat the
following property:
Project: SW 37TH TERR IMPROVEMENTS VIC OF 5720 SW 37TH TERRACE
DANIA BEACH FL 33312
The waiver and release does not cover any retention of labor, services and/or materials
furnished after the date specified.
Dated on ________________________, 20_____.
Lienor’s name: _______________________
Address: ____________________________
____________________________
____________________________
By: _______________________________
STATE OF FLORIDA
COUNTY OF
I hereby acknowledge that the statements contained in the foregoing release of lien are
true and correct.
Sworn to and subscribed before me this _____ day of _______________, 20___.
Signature: _________________________________
Printed Name: ______________________________
Note: This is a statutory form prescribed by section 713.20, Florida Statutes (1996). Effective October 1st, 1996; a person may
not require a lienor to furnish a waiver or release of lien that is different from the statutory form.
January 13 23
Herc Rentals, Inc.
27500 Riverview Center Blvd
Bonita Springs, FL 34134
LEE
13 January 23
Sandra Licci