"Certification of Title, Right of Entry and Waiver of Lien for Materials Stored or to Be Stored for Incorporation Into a State of Connecticut Department of Transportation Project" - Connecticut

Certification of Title, Right of Entry and Waiver of Lien for Materials Stored or to Be Stored for Incorporation Into a State of Connecticut Department of Transportation Project is a legal document that was released by the Connecticut Department of Transportation - a government authority operating within Connecticut.

Form Details:

  • Released on February 22, 2012;
  • The latest edition currently provided by the Connecticut Department of Transportation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Connecticut Department of Transportation.

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Download "Certification of Title, Right of Entry and Waiver of Lien for Materials Stored or to Be Stored for Incorporation Into a State of Connecticut Department of Transportation Project" - Connecticut

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STATE OF CONNECTICUT
CERTIFICATION OF TITLE, RIGHT OF ENTRY AND WAIVER OF LIEN
FOR MATERIALS STORED OR TO BE STORED
FOR INCORPORATION INTO A STATE OF CONNECTICUT DEPARTMENT OF
TRANSPORTATION PROJECT
WHEREAS ____________________________________________________________________ (the "Contractor") is
engaged in the performance of a contract with the State of Connecticut Department of Transportation (the "Department") for the construction of
a certain project designated as Project No. _____________________(the “Project”), and
WHEREAS the Contractor has purchased certain materials ( the “Material”) for the performance of the Project
contract; namely (List the identifying information required by the Construction Manual for the material in the space below or
reference an attached page for a lengthy list):
By signing this certification, the undersigned Contractor, Subcontractor, Vendor, Distributor, Lessoer,
Lessee and Owner of the real property where the Material is stored agree:
1. The State of Connecticut and its agents are now and until such time as all the Material shall have been
removed from the Property, are granted the right to enter the Property where the material is stored and to
inspect and inventory the Material, and to remove the material if the Contractor cannot deliver and install it
at the Project site upon the demand of the State of Connecticut or its agents.
2. All undersigned parties hereby waive any right that they might have to place a lien on, or otherwise
encumber or withhold from the State of Connecticut and its agents, the Material for any reason, now and
forever.
CONTRACTOR
WITNESS
________________________________________________________
By __________________________________________________________________________
By _________________________________________
Title _____________________________________________________
Title ____________________________
Dated:____________________________________________________
Date ____________________________
(rev. 2/22/12)
STATE OF CONNECTICUT
CERTIFICATION OF TITLE, RIGHT OF ENTRY AND WAIVER OF LIEN
FOR MATERIALS STORED OR TO BE STORED
FOR INCORPORATION INTO A STATE OF CONNECTICUT DEPARTMENT OF
TRANSPORTATION PROJECT
WHEREAS ____________________________________________________________________ (the "Contractor") is
engaged in the performance of a contract with the State of Connecticut Department of Transportation (the "Department") for the construction of
a certain project designated as Project No. _____________________(the “Project”), and
WHEREAS the Contractor has purchased certain materials ( the “Material”) for the performance of the Project
contract; namely (List the identifying information required by the Construction Manual for the material in the space below or
reference an attached page for a lengthy list):
By signing this certification, the undersigned Contractor, Subcontractor, Vendor, Distributor, Lessoer,
Lessee and Owner of the real property where the Material is stored agree:
1. The State of Connecticut and its agents are now and until such time as all the Material shall have been
removed from the Property, are granted the right to enter the Property where the material is stored and to
inspect and inventory the Material, and to remove the material if the Contractor cannot deliver and install it
at the Project site upon the demand of the State of Connecticut or its agents.
2. All undersigned parties hereby waive any right that they might have to place a lien on, or otherwise
encumber or withhold from the State of Connecticut and its agents, the Material for any reason, now and
forever.
CONTRACTOR
WITNESS
________________________________________________________
By __________________________________________________________________________
By _________________________________________
Title _____________________________________________________
Title ____________________________
Dated:____________________________________________________
Date ____________________________
(rev. 2/22/12)
SUBCONTRACTOR
WITNESS
_______________________________________________________
By __________________________________________________________________________
By _________________________________________
Title _____________________________________________________
Title ____________________________
Dated:____________________________________________________
Date ____________________________
VENDOR
WITNESS
_______________________________________________________
By __________________________________________________________________________
By _________________________________________
Title _____________________________________________________
Title ____________________________
Dated:____________________________________________________
Date ____________________________
PROPERTY LESSOR
WITNESS
_______________________________________________________
By __________________________________________________________________________
By _________________________________________
Title _____________________________________________________
Title ____________________________
Dated:____________________________________________________
Date ____________________________
PROPERTY LESSEE
WITNESS
_______________________________________________________
By __________________________________________________________________________
By _________________________________________
Title _____________________________________________________
Title ____________________________
Dated:____________________________________________________
Date ____________________________
PROPERTY OWNER
WITNESS
_______________________________________________________
By __________________________________________________________________________
By _________________________________________
Title _____________________________________________________
Title ____________________________
Dated:____________________________________________________
Date ____________________________
(rev. 2/22/12)
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