STATE OF _________________________
_________________ OF _______________
On this _____ day of ____________, 20_____, before me personally appeared _________
_______________________ Owner of Property, and _____________________________ General Contractor, to me personally known, who, being duly sworn on their oaths, did say that all of the persons, firms and corporations, including the general contractor and all subcontractors, who have furnished services, labor or materials according to plans and specifications, or extra items used in the construction or repair of buildings and improvements on the real estate hereinafter described, have been paid in full and that such work has been performed to satisfaction and accepted by owner and general contractor as of date herein.
Affiants further say that no claims have been made to either the affiants by, nor is any suit now pending against affiants by any contractor, subcontractor, laborer or materialman, and further that no chattel mortgages or conditional bills of sale, security agreements or financing statements have been given or are outstanding as to any materials, appliances, fixtures or furnishings placed upon or installed in the aforesaid premises.
Affiants as parties hereto do for a valuable consideration hereby agree and guarantee to hold Stewart Title Guaranty Company (by reason of the fact that it has issued its title insurance policies), harmless against any lien, claim or suit of or by any general contractor, subcontractor, mechanic or materialman, and against chattel mortgages or conditional bills of sale, security agreements or financing statements in connection with the construction or repair of such building or improvements on said real estate.
The real estate and improvements referred to herein are situated in the _______________
of ____________________, State of ___________________, and are described as follows, to-wit:
__________________________________ Owner of Property
__________________________________ Owner of Property
__________________________________ General Contractor
Executed, subscribed and sworn to before me the day and year above written. __________________________________
Notary Public
NOTE: FOR USE WHEN OWNER AND GENERAL CONTRACTOR ARE NOT THE SAME.
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