General Contractor's Affidavit

GENERAL CONTRACTOR'S AFFIDAVIT

STATE OF WEST VIRGINIA,

COUNTY OF ______, to-wit,

______(name of Officer or Owner of Contractor), being first duly sworn upon his oath, deposes and says:

1.The undersigned is an officer/owner of ______(name of Contractor), and that this Affidavit is made for the purpose of inducing the WV Development Office to disburse all or a portion of the proceeds of NSP Funds evidenced by the Agreement executed by the WV Development Office and ______(name of Subrecipient), dated ______, all relating to the financing of certain contractor’s construction costs upon the real property more particularly described and referred to in the Agreement, an NSP project in or near ______, commonly known as ______(name or street address of project, and hereinafter sometimes called the “Project”).

2.That the Contractor is duly authorized to hold property and transact business in the State of West Virginia, and as such, is familiar with all arrangements respecting all on-site and off-site work to be done in connection with the construction of the Project and the arrangements for payment for said work, all as contained and set forth in the said Agreement and the Construction Contract for the Project dated ______, made by as Owner and the Contractor.

3.That he has prepared or examined the Contractor's Requisition # ______submitted in the amount of $ due for work performed on the Project up to the day of , 2_____ (hereinafter sometimes called the “Draw Date”).

4.That the amounts shown in Column B of the Contractor's Requisition or on the AIA G 702 (as applicable) truly and correctly represent all labor and materials for all on-site or off-site work incorporated into the Project as of the Draw Date, or not incorporated into the Project site as of the Draw Date, and that such amounts represent such work, labor, and materials only.

5.That all persons, firms, and corporations who have furnished any materials or done any work or labor for the Project under contract with (name of Contractor)have been fully paid all sums due and payable for all such materials furnished and work and labor done, up to the Draw Date, or will be so fully paid from the funds requested under the Contractor's Requisition dated ______, except ______, all of whom have executed a Waiver of Mechanics'/Materialmen's Lien, executed copies of which are attached hereto.

6.That, to the best of his knowledge, information, and belief:

a.all persons, firms, and corporations who have furnished labor or materials for on-site or off-site work other than under contract with ______(name of Contractor)have been fully paid for all such labor and materials furnished up to the Draw Date, or will be so fully paid from funds immediately or immediately derived from the funds requested by the Contractor's Requisition;

b.the proceeds were on the Draw Date, and now are “in balance” within the meaning of the Agreement; and

c.the Project can and will be completed for the amount on the schedule and in accordance with all other arrangements therefore between ______and .

By:

STATE OF WEST VIRGINIA,

COUNTY OF , to-wit:

Taken, subscribed, and sworn to before me this ____ day of , 2 .

My commission expires .

Notary Public

General Contractor’s AffidavitPage 1 of 2NSP