West Columbia Economic Development Corporation-Certification of Completion

FACADE IMPROVEMENT SIGN IMPROVEMENT

PROPERTY IMPROVEMENT

Applicant Name:*

Business Name:

AFFIDAVIT

I CERTIFY that all improvements have been satisfactorily completed in accordance to the approved application, that all charges or bills for labor or services performed or materials furnished, and other charges against the subcontractors, have been paid in full and in accordance with the terms of the contract; that no liens have been attached against the property and improvements of owner; that no notice of intention to claim liens is outstanding; that no suits are pending by reason on the project under the contract; that all Worker's Compensation claims have been settled and no public liability claims are pending.

Affidavit is made for the purpose of reimbursement of funds according to the West Columbia Business Improvement Program.

Total of Paid Receipts submitted for reimbursement.*

Business Owner's Signature*

Printed Name & Date

Property Owner's Signature

Printed Name & Date

Attachments

Copies of paid receipts Photographs of completed work

Other __________________________

Sworn to and subscribed before me, a notary public,

this

day of

Notary Public Signature*

(seal)

INSPECTION

I CERTIFY that I have inspected the project and have found all improvements to be satisfactorily completed in accordance to the approved application and in compliance to any applicable city ordinances.

Inspector's Signature

Printed Name

(Adopted 03/29/2010)