ࡱ> ` bbjbjss 2 '''8'<6(Lj?*)l****+,I-H>>>>>>>$@hB>]u.++u.u.>**$?111111u.d**>11u.>1111:%6,6*) %2'.XQ6 6:?0j?[6RC1/C6C6-"-11----->>0X---j?u.u.u.u."''$? State of Illinois CAPITAL DEVELOPMENT BOARD CFDCONTRACTOR S FINAL DECLARATIONProject No.: FORMTEXT      CONTRACTOR: (Name, Address)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       PROJECT: (Name, City, County)  FORMTEXT        FORMTEXT        FORMTEXT       CDB Contract No.:  FORMTEXT      Using Agency:  FORMTEXT      Contract Work:  FORMTEXT      The undersigned Contractor has been employed by CDB to perform the Contract Work. In accordance with the Contract, the Contractor hereby provides: A.AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, certifying that he has paid in full or otherwise satisfied all obligations for all materials and equipment furnished, for all work, labor and services performed, and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract for which CDB, the Using Agency, or their properties might in any way be held responsible.D.FINAL CONTRACT AMOUNT:$ FORMTEXT      CONTRACTOR:  FORMTEXT      By:(Signature)Title: FORMTEXT      B.AFFIDAVIT OF RELEASE OF LIENS, certifying that to the best of his knowledge, information and belief, that the attached Final Waivers of Lien include the contractor(s), and all subcontractors, all suppliers of materials and equipment, and all performers of work, labor or services arising in any manner out of the performance of the Contract.NOTARY PUBLIC:  FORMTEXT      Subscribed and sworn to before me this FORMTEXT      day of FORMTEXT      , FORMTEXT      .C.RELEASE of all claims against CDB arising by virtue of the Contract.(Signature)CZbdfhn  J L ` b d n p r t ˜˜n˜)jh4lCJOJQJU^JaJ)j1h4lCJOJQJU^JaJ(jCJOJQJU^JaJmHnHu)jh4lCJOJQJU^JaJ#jh4lCJOJQJU^JaJh4l5CJOJQJ^JaJh4l5CJ(OJQJ^JaJ(h4lCJOJQJ^JaJ#$XZbdfhjlSkd$$Ifl40;*` t44 la $$Ifa$$If$a$ zbbln-ekdV$$IflF)#;* t    44 la$Iffkd$$Ifl4F)#;*  t    44 la  ekd$$IflF)#;* t    44 la$If     tnnn$Ifkd $$IflrP)#;*Xd9  t44 la   J r U?kd$$Ifl;**  t44 la$Ifekd$$IflF)#;* t    44 la * , @ B D N P R T h j l v x z | صصصصصصvصصaصص)jh4lCJOJQJU^JaJ)juh4lCJOJQJU^JaJ)jh4lCJOJQJU^JaJ)jh4lCJOJQJU^JaJh4lCJOJQJ^JaJ(jCJOJQJU^JaJmHnHu#jh4lCJOJQJU^JaJ)jh4lCJOJQJU^JaJ# * R z 8 Tkda$$Ifl0d;*   t44 la$If   & ( * 4 6 X Z n p r | ~ \ _ @lrtصصصصص}n}n}\}G)j h4lCJOJQJU^JaJ#jh4lCJOJQJU^JaJh4l5CJOJQJ^JaJh4lCJOJQJ^JaJ)j} h4lCJOJQJU^JaJ)jx h4lCJOJQJU^JaJh4lCJOJQJ^JaJ(jCJOJQJU^JaJmHnHu#jh4lCJOJQJU^JaJ)j h4lCJOJQJU^JaJ8 : URkd $$Ifl0d;* t44 la$IfRkd $$Ifl0d;* t44 la Z [ \ y:?kd $$Ifl;** t44 laAkd $$Ifl~;**  t44 la$If?kd $$Ifl;**  t44 la\ _ 8:@nr $$Ifa$$If,.BDXZ\fhnp~9:DE ʼʼʧʼʼʼʒʼʼʼʼʃn)jh4lCJOJQJU^JaJh4l5CJOJQJ^JaJ)jh4lCJOJQJU^JaJ)jh4lCJOJQJU^JaJh4lCJOJQJ^JaJh4lCJOJQJ^JaJ(jCJOJQJU^JaJmHnHu#jh4lCJOJQJU^JaJ+LFFFFFFF$Ifkd $$Ifl4֞h"#;*``L`3 h t44 laLFFFF$Ifkd$$Ifl4֞h"#;*  L 3 h t44 la$Ifykd%$$Ifl4\h;*  L m t44 la ,LFFFFFF$Ifkd$$Ifl4֞h"#;*  L 3 h t44 la,.024Bjln_YYYYYYY$Ifkd$$Ifl4ֈh%;*  L 3 C t44 lanprtvxz|~LFFFFFFF$Ifkd$$Ifl4֞h"#;*  L 3 h t44 la~LFFFFFFF$Ifkd$$Ifl4֞h"#;*  L 3 h t44 laLFFFFFFF$Ifkd$$Ifl4֞h"#;*  L 3 h t44 la)*LF=FF $$Ifa$$Ifkd$$Ifl4֞h"#;*  L 3 h t44 la   .0"$*,:<BP߼ߒ}nh4l5CJOJQJ^JaJ)j'h4lCJOJQJU^JaJ)jh4lCJOJQJU^JaJ(jCJOJQJU^JaJmHnHu)j5h4lCJOJQJU^JaJh4lCJOJQJ^JaJh4lCJOJQJ^JaJ#jh4lCJOJQJU^JaJ+$IfykdJ$$Ifl4\h;*``L m t44 la "$&(*,.LFFFFFFF$Ifkd$$Ifl4֞h"#;*  L 3 h t44 la.0246LFFFFF$Ifkd&$$Ifl4֞h"#;*  L 3 h t44 larlllllll$Ifkd$$Ifl4rh";*  L L ! t44 la&LFFFFFFF$Ifkd$$Ifl4֞h"#;*  L 3 h t44 la&*,.023kd$$Ifl4ִhP"#&;*  L h\] t    44 la$If2468:<BFkd$$Ifl4֞h"#;*  L 3 h t44 la$IfBckd $$Ifl4rh%;*``L *C t44 la$If $$Ifa$ Fkd!$$Ifl4֞h"#;*  L 3 h t44 la$IfR\T\\\\\\Jfkd#$$Ifl4F;*`  ` m  t    44 la$If $$Ifa$?kd #$$Ifl;**  t44 laZ"Z\\\\\\\\\\\\\] ]]](]*],]6]8]V]X]Z]\]4bzb|bbbbbӬӂte``` jUh4l5CJOJQJ^JaJh4lCJOJQJ^JaJ)jt'h4lCJOJQJU^JaJ(jCJOJQJU^JaJmHnHu)jT$h4lCJOJQJU^JaJ#jh4lCJOJQJU^JaJh4lCJOJQJ^JaJUh4l5CJOJQJ^JaJh4lCJOJQJ^JaJ%ONSENT OF SURETY. In accordance with the Contract between CDB and the Contractor, Surety, on bond of the Contractor, hereby approves of the final payment to the Contractor. Surety agrees that final payment shall not relieve Surety of any of its obligations to CDB as set forth in Surety s Bond.SURETY COMPANY: (Name) FORMTEXT      By:(Signature)Attorney-in-Fact FORMTEXT      (Typed name)JURAT (Notary s Statement Authenticating Signature)STATE OFCOUNTY OFI,, a Notary Public in and for said county, do hereby certify that(Insert Name of Attorney-in-Fact for SURETY)who is personally known to me to be the same person whose name is subscribed to the foregoing instrument on behalf of SURETY, appeared before me this day in person and acknowledged respectively, that he/she signed, sealed, and delivered said instrument as his/her free and voluntary act for the uses and purposes therein set forth.Given under my hand and notarial seal thisDAY OFA.D.Notary Signature Attach Surety s Power of Attorney     Revised 06/05 \\\\\\\$Ifhkd$$$Ifl4F;*   m t    44 la\\\\\]]]rllllll$Ifkd%$$Ifl4r%;*   3 C t44 la] ] ]]]]:]<]V]_YYYYYYY$Ifkdr&$$Ifl4ֈ"#;*   3 h t44 laV]X]Z]NH$Ifkd'$$Ifl֞h"#;*L3 h t44 laZ]\]]]]]]xrrr$If?kdn)$$Ifl;**  t44 la $$Ifa$?kd($$Ifl;**  t44 la]]]]]]]SAkd*$$Ifl~;** t44 la$Ifekd)$$IflFP ;*Xd t    44 la]]]^^^ ^^SAkd+$$Ifl~;** t44 la$Ifekd%+$$IflFP ;*Xd t    44 la^^^^^@7 $$Ifa$Akd*-$$Ifl;** t44 la$IfxkdU,$$Ifl\;*h\ [ t44 la^^^^aayp1?kd.$$Ifl;** t44 la $$Ifa$Akd<.$$Ifl~;** t44 la$If?kd-$$Ifl;** t44 laaaaaaaabbb?kd2/$$Ifl;** t44 la$If bb bNH$Ifkd/$$Ifl֞ 4 t";*B t44 la b b.b0b2b4b6bzb~bSNNL$a$ekdU1$$IflFT4;* t    44 la$IfAkd0$$Ifl~;** t44 la~bbbbbbbbbbbb$a$ bbbbbbbbh4l5CJOJQJ^JaJhnCJaJCJaJ jU0&P1h/ =!"#$% $$If!vh55 #v#v :Vl4 t0+,,55 $$If!vh555#v#v#v:Vl4 t0+,555$$If!vh555#v#v#v:Vl t0,555$$If!vh555#v#v#v:Vl t0,555tDText1$$If!vh5X5d59 55#vX#vd#v9 #v#v:Vl t0,5X5d59 55/ $$If!vh555#v#v#v:Vl t0555$$If!vh5*#v*:Vl t05*/  tDText5tDText6tDText7tDText8tDText9vDText10vDText11$$If!vh55#v#v:Vl t055/  vDText12vDText14$$If!vh55#v#v:Vl t055vDText13$$If!vh55#v#v:Vl t055$$If!vh5*#v*:Vl t05*/  $$If!vh5*#v*:Vl~ t05*/  w$$If!vh5*#v*:Vl t05*vDText15$$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5/  $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5vDText16$$If!vh55L55m#v#vL#v#vm:Vl4 t0+++55L55m $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5$$If!vh55L5535 5C#v#vL#v#v3#v #vC:Vl4 t0+++,,55L5535 5C/ vDText17$$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5/  $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5 $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5 $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5vDText18$$If!vh55L55m#v#vL#v#vm:Vl4 t0+++55L55m $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5 $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5vDText20$$If!vh55L55L 5!#v#vL#v#vL #v!:Vl4 t0+++,55L55L 5!/  $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5vDText19vDText20Q$$If!vh55L5555h5\5]#v#vL#v#v#v#vh#v\#v]:Vl4 t0+++,,,55L5555h5\5]/ /  $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5$$If!vh55L55*5C#v#vL#v#v*#vC:Vl4 t0+++55L55*5C/ $$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl4 t0+++55L5535 5h5/ $$If!vh5*#v*:Vl t05*/  $$If!vh5 55m#v #v#vm:Vl4 t0++5 55m/  vDText19$$If!vh5 55m#v #v#vm:Vl4 t0++5 55m$$If!vh5 5535 5C#v #v#v3#v #vC:Vl4 t0++,5 5535 5C/ $$If!vh5 5535 5h5#v #v#v3#v #vh#v:Vl4 t0++5 5535 5h5/ vDText19$$If!vh55L5535 5h5#v#vL#v#v3#v #vh#v:Vl t055L5535 5h5$$If!vh5*#v*:Vl t05*/  $$If!vh5*#v*:Vl t05*/  $$If!vh5X5d5#vX#vd#v:Vl t05X5d5/ {$$If!vh5*#v*:Vl~ t05*$$If!vh5X5d5#vX#vd#v:Vl t05X5d5/ {$$If!vh5*#v*:Vl~ t05*$$If!vh55h5\ 5[#v#vh#v\ #v[:Vl t0,,55h5\ 5[/ $$If!vh5*#v*:Vl t05*/ $$If!vh5*#v*:Vl t05*/ {$$If!vh5*#v*:Vl~ t05*w$$If!vh5*#v*:Vl t05*w$$If!vh5*#v*:Vl t05*+$$If!vh5B555555#vB#v#v#v#v#v#v:Vl t0,5B555555/ / / {$$If!vh5*#v*:Vl~ t05*$$If!vh555#v#v#v:Vl t0,555/ @@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List j@j Table Grid7:V0HH  Balloon TextCJOJQJ^JaJ4@4 Header  !4 @"4 Footer  ! 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L^`LhH. ^`hH. ^`hH. PLP^P`LhH.808^8`0o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.rTQ4CF        /K        -1234567VWXYZ[\]j~STz[\_ 79MNOPQRSTUVWXYyz{|}~)*MNOPQRSTUVWXYZ[\]^_`a,-.:;<=>?@ABCDEop( ) 2 3 4 5 6 7 A B C D E F G J K  9 : A B G H I J K L ] ^ _ ` @XFF pp p@pp @ppZUnknownGz Times New Roman5Symbol3& z Arial=" Arial (W1)5& zaTahoma"1h+&ssF  !4d~ ~ 2QHX ?*Contractor's Final DeclarationK Fredrickson 06/05r, 03/07 Administrator  Oh+'0(< T`     Contractor's Final DeclarationK Fredrickson 06/05r, 03/07Web, Procedures and Forms Normal.dotAdministrator6Microsoft Office Word@0@k@AXI@# rchive  ContractorFormProcedures & FormsContractor's Final Declaration0~  ?@BCDEFGHIJKLMNOPQRSTUVWXYZ\]^_`abcdefghijklmnopqrstuvwxyz{|~Root Entry F@ՕiData A21Table[CWordDocument2SummaryInformation(}DocumentSummaryInformation8XCompObjqMsoDataStore@ҕi@ҕi  !  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