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 fully completed and accepted by owner.
Affiants further say that no claims have been made to either of the affiants by, nor is any suit pending against affiants by any contractor, subcontractor, laborer or materialman, and further that no chattel mortgages, 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 or will issue in the future 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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