The Michigan Sworn Statement form is a legal document used to declare the status of payments due to subcontractors, suppliers, and laborers involved in public works projects. This form ensures transparency and protects all parties by confirming that the project is free from claims of construction or bond liens. If you need to fill out the form, click the button below.
The Michigan Sworn Statement form serves a critical role in the realm of construction and public works projects. This document is designed to provide transparency regarding the financial obligations between contractors, subcontractors, suppliers, and laborers involved in a public improvement project. When filled out, it details the names of all parties who have contributed labor or materials, alongside the amounts owed to them. This ensures that everyone involved is aware of any outstanding payments for wages or fringe benefits, helping to prevent disputes over unpaid debts. Additionally, the form includes a declaration that the contractor or supplier has not engaged with any other parties outside of those listed, reinforcing accountability. It also serves as a formal assurance to project owners and general contractors that the work is free from potential claims or liens, except where specifically noted. The consequences of providing false information are serious, as the form includes a warning about the legal repercussions of fraud. Thus, the Michigan Sworn Statement form is not just a procedural requirement; it is a vital tool for maintaining trust and integrity in the construction industry.
SWORN STATEMENT
STATE OF MICHIGAN
)
) ss.
COUNTY OF
<<<name of person signing sworn statement>>>, being duly sworn, deposes and says: That <<<name of company>>> is a/the <<<select one>>>(contractor)(subcontractor)(supplier) for an improvement to the following described public works situated in __________ County, Michigan, described as follows:
Contract No. <<<MDOT Contract ID Number>>> Project Name: <<<eg. I-96 from U.S 23 to Kent Road>>>
That the following is a statement of each subcontractor and supplier and laborer, for which laborer the payment of wages or fringe benefits and withholdings is due but unpaid, with whom the <<<same selection as above>>>(contractor)(subcontractor)(supplier) has <<<select one>>>(contracted)(subcontracted)(supplied material)(supplied labor) for performance under the contract with the owner, lessee, or general contractor thereof, and that the amounts due to the persons as of the date hereof are correctly and fully set forth opposite their names, as follows:
Name of Subcontractor,
Type of
Total
Amount
Balance
Amount of
Amount of Laborer
Supplier, or Laborer
Improvement Furnished
Contract
Already
Currently
to
Laborer
Retention
Fringe Benefits
Price
Paid
Owing
Complete
Wages Due
and Withholdings
But Unpaid
Due But Unpaid
SUB TOTALS
TOTALS
That the (contractor) (subcontractor) has not procured material from, or subcontracted with, any person other than those set forth on the reverse side and owes no money for the improvement other than the sums set forth on the reverse side.
Deponent further says that he or she makes the foregoing statement as the (contractor)(subcontractor)(supplier) or as <<<authorized agent if signator is not officer or employee of company>>> of the (contractor)(subcontractor)(supplier) for the purposes of representing to the owner, lessee, or general contractor of the public works described on the reverse side and his or her agents that the public works described on the reverse side is free from claims of construction or bond liens, or the possibility of construction or bond liens, except as specially set forth on the reverse side hereof..
WARNING TO DEPONENT: A PERSON, WHO WITH INTENT TO DEFRAUD, GIVES A FALSE SWORN STATEMENT FOR THE PURPOSE OF OBTAINING PAYMENT IS SUBJECT TO CRIMINAL and CIIVIL PENALTIES AS PROVIDED BY LAW.
(Deponent)
Subscribed and sworn to before me this
day of
, 20___.
, Notary Public
County, Michigan
My commission expires:
Acting in _______________ County
91742v2
__________________
, being duly sworn, deposes and says: That ______________________
is a/the (contractor)(subcontractor)(supplier) for an improvement to
the following described public works situated in _______ County, Michigan, described as follows:
Contract No.
; Project Name:
That the following is a statement of each subcontractor and supplier and laborer, for which laborer the payment of wages or fringe benefits and withholdings is due but unpaid, with whom the (contractor)(subcontractor)(supplier) has (contracted)(subcontracted)(supplied material)(supplied labor) for the improvement on the above referenced public works project and that the amounts due to the persons as of the date hereof are correctly and fully set forth opposite their names, as follows:
Deponent further says that he or she makes the foregoing statement as the (contractor)(subcontractor)(supplier) or as _____ ____ of the (contractor)(subcontractor)(supplier) for
the purposes of representing to the party from whom payment is requested and to the prime contractor who has furnished a payment bond covering the public works project described on the reverse side and his or her agents that the public works described on the reverse side is free from claims of payment bond liens, or the possibility of payment bond liens, except as specially set forth on the reverse side hereof.
91742
FULL CONDITIONAL WAIVER
Our contract with <<<name of company>>> to furnish<<<general description of
work/material furnished. Eg. Concrete work and related items. Eg. Aggregate
materials>>> materials to <<<MDOT>>> Project No. <<<MDOT Contract ID
Number>>> has been fully paid and satisfied with respect to our rights under the Payment / Lien Bond covering said Project and all of our rights to pursue payment under the Payment/Lien Bond No. _____________ issued by <<<name of prime
contractor>>> as principal and <<<name of payment bond surety>>> as surety,
together with any rights, demands, or causes of action we may have against _<<<name
of prime contractor>>> or <<<name of payment bond surety>>>, are hereby fully waived and released and the “Notice of Lien Claim” (if any) dated ,<<<insert “N/A” if none. Insert date of Notice of Lien Claim if one has been filed>>> and any amendment(s) thereto, is hereby rescinded.
This waiver is
conditioned upon our receipt of payment in the amount of
$<<<amount of payment for which waiver is being given>>>
<TYPE OR PRINT COMPANY NAME>
__________________________
by:
<<type or print name>>
its:
<<type or print title>>
) SS
The signator is known to me and acknowledged the foregoing instrument this
___ day of ________, 20___.
________________________________
____________________, Notary Public
_____________County, Michigan
My commission expires: ___________
Acting In _____________ County
91748v2
Our contract with _________________ to furnish ______________________
materials to _______ Project No. _____________ has been fully paid and satisfied with
respect to our rights under the Payment / Lien Bond covering said Project and all of our rights to pursue payment under the Payment/Lien Bond No. _____________ issued by
_______________________ as principal and ____________________ as surety,
together with any rights, demands, or causes of action we may have against
_____________________ or __________________ , are hereby fully waived and
released and the “Notice of Lien Claim” (if any) dated _______________, and any
amendment(s) thereto, is hereby rescinded.
This waiver
is
$
.
___________________________
_____________________
91748
FULL UNCONDITIONAL WAIVER
Our contract with <<<name of company>>> to furnish general description of work/material furnished. Eg. Concrete work and related items. Eg. Aggregate
materials>>>
materials to <<<MDOT>>> Project No. <<<MDOT Contract ID
Number>>>
has been fully paid and satisfied with respect to our rights under the
Payment / Lien Bond covering said Project and all of our rights to pursue payment under the Payment/Lien Bond No. _____________ issued by <<<name of prime
contractor>>> as principal and <<<name of payment bond surety>>> as surety, together with any rights, demands, or causes of action we may have against <<<name
of prime contractor>>> or <<<name of payment bond surety>>> , are hereby fully waived and released and the “Notice of Lien Claim” (if any) dated ,<<<insert “N/A” if none. Insert date of Notice of Lien Claim if one has been filed>>>, and any amendment(s) thereto, is hereby rescinded.
by: <<type or print name>>
its: <<type or print title>>
___ day of ___________, 20___.
Notary Public
91747v2
materials to ______ Project No._________________ has been fully paid and satisfied
with respect to our rights under the Payment / Lien Bond covering said Project and all of our rights to pursue payment under the Payment/Lien Bond No. _____________ issued
by _______________________ as principal and ____________________ as surety,
91747
PARTIAL CONDITIONAL WAIVER OF LIEN
Our contract with <<<name of company>>> to furnish <<<general description of work/material furnished. Eg. Concrete work and related items. Eg. Aggregate
materials>>>to <<<MDOT>>> Project No. <<<MDOT Contract ID Number>>> has
been partially paid and satisfied in the amount of $<<<amount of payment for which waiver is being given>>>with respect to our rights under the Payment / Lien Bond covering said Project and our rights to pursue payment under the Payment/Lien Bond
No.issued by <<<name of prime contractor>>> as principal and
<<<name of payment bond surety>>> as surety, together with any rights, demands, or causes of action we may have against <<<name of prime contractor>>> or <<<name
of payment bond surety>>> are hereby waived and released to the extent of said partial payment of $ <<<amount of payment for which waver is being given>>> and the “Notice of Lien Claim” (if any) dated ,<<<insert “N/A” if none. Insert date of Notice of Lien Claim if one has been filed>>> and any subsequent amendment(s) thereto, are hereby rescinded, waived and released for the amount of $ <<<amount of payment for which waiver is being given>>> and are hereby amended to reflect only the remaining balance claimed to be due under our contract in the amount of $<<<remaining balance after deduction of all partial payments to date>>>.
This waiver is conditioned upon our receipt of payment in the amount of
$<<<amount of payment for which waver is being given>>>
______________________________
91744v2
Our contract with ___________________________ to furnish _____________,
__________________________________ to _________________________ Project
No. _________________________________ has been partially paid and satisfied in
the amount of $___________with respect to our rights under the Payment / Lien Bond
covering said Project and our rights to pursue payment under the Payment/Lien Bond No. _____________ issued by ____________________________ as principal and
____________________________ as surety, together with any rights, demands, or
causes of action we may have against __________________________ or
_______________________________________ are hereby waived and released to the
extent of said partial payment of $_________ and the “Notice of Lien Claim” (if any)
dated _________________________, and any subsequent amendment(s) thereto, are
hereby rescinded, waived and released for the amount of $____________ and are
hereby amended to reflect only the remaining balance claimed to be due under our
contract in the amount of $___________.
91744
Filling out the Michigan Sworn Statement form is a crucial step in ensuring that all parties involved in a public works project are accurately represented regarding payments due. Following the steps below will help you complete the form correctly and efficiently.
Once the form is completed and notarized, it should be submitted to the appropriate parties involved in the public works project. Ensure that all details are accurate to avoid any potential legal issues.
What is a Michigan Sworn Statement?
A Michigan Sworn Statement is a legal document used primarily in the construction industry. It provides a formal declaration of the payment status of subcontractors, suppliers, and laborers involved in a public works project. The statement ensures that all parties involved are aware of any outstanding payments and helps protect against potential claims or liens on the property.
Who needs to file a Michigan Sworn Statement?
This form is typically required by contractors, subcontractors, and suppliers who are working on public works projects in Michigan. If you are responsible for paying laborers or subcontractors, you must complete this statement to confirm that all payments are up to date and that no claims are pending.
What information is required on the form?
The Michigan Sworn Statement requires several key pieces of information, including:
What happens if I do not file this statement?
Failing to file a Michigan Sworn Statement can lead to serious consequences. Without this documentation, you may expose yourself to claims or liens against the property. Additionally, it could affect your ability to receive payment for your work or materials provided.
Is there a penalty for providing false information?
Yes, there are significant penalties for providing false information on a Michigan Sworn Statement. If someone is found to have intentionally misrepresented facts to obtain payment, they could face both criminal and civil penalties under Michigan law. It is crucial to ensure that all information is accurate and truthful.
How do I complete the form?
To complete the Michigan Sworn Statement, follow these steps:
Make sure to double-check all entries for accuracy before submission.
Where do I submit the completed form?
The completed Michigan Sworn Statement should be submitted to the owner, lessee, or general contractor of the public works project. Keep a copy for your records, as it may be needed for future reference.
Can I amend the sworn statement after it has been submitted?
If there are changes to the information provided in the sworn statement, you may need to file an amended version. This ensures that all parties have the most current and accurate information regarding payments and claims.
Is legal assistance recommended when completing this form?
While it is not mandatory to seek legal assistance, it can be beneficial, especially if you are unfamiliar with the process or if the project involves significant sums of money. A legal professional can help ensure that the statement is completed correctly and that your rights are protected.
When filling out the Michigan Sworn Statement form, individuals often make several common mistakes that can lead to complications. One frequent error is failing to complete all required fields. The form has specific sections that need to be filled out, including the names of the contractor, subcontractor, or supplier, as well as the contract number and project name. Omitting any of these details can render the statement incomplete and may cause delays in processing.
Another mistake involves selecting incorrect options in the dropdown sections. The form requires individuals to indicate whether they are a contractor, subcontractor, or supplier, as well as the nature of their contractual relationship. Misselecting these options can lead to misunderstandings regarding the responsibilities and rights associated with the statement.
Inaccurate financial information is another common issue. It is essential to provide accurate totals for amounts owed, paid, and retained. Errors in these figures can result in disputes and potential legal consequences. Individuals must ensure that they double-check their calculations and confirm that all amounts correspond with supporting documentation.
Additionally, some individuals fail to provide a complete list of subcontractors, suppliers, and laborers. The form requires a detailed account of all parties involved in the project, along with the amounts due. Neglecting to include any party can create gaps in accountability and may lead to claims of unpaid wages or benefits.
Another mistake is not signing the document correctly. The form must be signed by the appropriate individual, whether it be the contractor, subcontractor, or an authorized agent. Failing to sign the document or using an unauthorized signature can invalidate the sworn statement.
Finally, individuals sometimes overlook the notary requirement. The form must be notarized to verify the identity of the signer and the authenticity of the statement. If the notary section is not completed, the statement may not be legally binding, which could have significant implications for all parties involved.
The Michigan Sworn Statement form is an essential document in the construction industry, particularly for public works projects. It helps ensure that all parties involved are aware of the financial obligations tied to the project. Alongside this form, several other documents are commonly used to support and clarify the financial relationships and obligations. Here’s a list of related forms that you may encounter:
These documents play a crucial role in ensuring clarity and accountability in construction projects. Understanding their purposes can help all parties navigate the complexities of project financing and compliance.
The Michigan Sworn Statement form is a crucial document in construction and public works projects. It shares similarities with several other important documents. Here’s a list of ten documents that are similar to the Michigan Sworn Statement form:
When filling out the Michigan Sworn Statement form, attention to detail is crucial. Here are five important dos and don'ts to guide you through the process:
Understanding the Michigan Sworn Statement form is crucial for contractors, subcontractors, and suppliers involved in public works projects. However, several misconceptions can lead to confusion. Here are eight common misconceptions explained:
In reality, the Michigan Sworn Statement is often a requirement for securing payment on public works projects. Not submitting it can jeopardize payment.
All parties involved, including subcontractors and suppliers, must complete and submit their own sworn statements to ensure they are protected from lien claims.
While it is a necessary step in the payment process, it does not guarantee that payment will be received. It is one part of a larger contractual obligation.
This form should be submitted in a timely manner, often as part of the payment request process. Delays can affect payment timelines.
Providing false information on the sworn statement can lead to serious legal consequences, including criminal charges. Accuracy is essential.
The sworn statement is applicable to various public works projects, not just those funded by the state. Any public project may require it.
While it is important to submit accurate information initially, amendments can be made if circumstances change. However, proper procedures must be followed.
This form specifically addresses payment claims related to labor and materials. It does not cover all potential legal claims that may arise.
Awareness of these misconceptions can help ensure compliance and protect your rights in the construction process. Taking the time to understand the requirements will benefit all parties involved.
When filling out and using the Michigan Sworn Statement form, consider the following key takeaways: