Form 19-5

Exhibit F
Subcontractor Bills-Paid Affidavit

Basic Information

Date:

Owner:

Owner’s Mailing Address:

Subcontractor:

Subcontractor’s Mailing Address:

Contractor:

Contractor’s Mailing Address:

Affiant: [include relationship to subcontractor]

Affiant’s Mailing Address:

Property: [include legal description]

Improvements:

Affiant swears individually and on behalf of Subcontractor that the following state­ments are true and within the personal knowledge of Affiant:

1.Affiant has personal knowledge of the facts stated in this affidavit. Affiant has full authority to make the agreements in this affidavit on behalf of Subcontractor.

2.Affiant understands that Owner and Contractor have required this affidavit as a condition of payment for labor or materials used in construction of the Improvements.

3.Subcontractor has paid each of Subcontractor’s subcontractors, laborers, and materialmen in full for all labor and materials provided to Owner or Contractor or to Subcon­tractor for construction of the Improvements, excepting only the amounts owed to the persons identified below:

Name:

Address:

Telephone number:

Amount owed:

Subcontractor warrants and represents that the following specified bills or classes of bills will be paid by Subcontractor from the funds paid to Subcontractor by Contractor or Owner in reliance on this affidavit:

Name of payee or description of class:

Amount:

Subcontractor agrees to indemnify and hold Owner and Contractor harmless from any loss or expense resulting from false or incorrect information in this affidavit.

   
[Name of affiant]

SUBSCRIBED AND SWORN TO before me on __________________ by [name of affiant].

   
Notary Public, State of Texas