Public Mechanics Lien/Bond Claim Form

Notice of Claim on Bond State of Alabama

Return To:

 

 

 

STATE OF ALABAMA
COUNTY OF

Code of Ala. § 39-1-1

CLAIMANT (Name & Principal Place of Business Address)

 

 

 

 

SURETY (Name & Address)

 

 

 

 

BOND NUMBER:

 

 

PRIME CONTRACTOR (Name & Address, state “Unknown” if not known)

 

 

 

 

HIRING PARTY (Name & Address of party who hired the CLAIMANT)

 

 

 

Services, labor, materials, equipment and/or work provided by the CLAIMANT (“ SERVICES”):

 

 

 

 

SERVICES supplied on the following described public improvement (the “IMPROVEMENT”) Give description of improvement:

 

 

 

Give address of improvement:

 

 

 

Contract Number:

 

AMOUNT DUE   $

 

 

DATE AMOUNT DUE became or will become due: Give description of improvement:

 

____/____/20___

 

 

 

 

 

 

 

 

 

 

 

 

NOTICE IS HEREBY GIVEN that CLAIMANT, undersigned, and above-identified, has performed construction work above identified as the SERVICES, in the construction of the public improvement above-identified as the IMPROVEMENT. In connection therewith, the CLAIMANT is owed the above-identified AMOUNT DUE.

As per the Code of Alabama §39-1-1, written notice is hereby provided to the surety on the project, upon information and belief above-identified to be the SURETY, of the amount claimed to be due and the nature of the claim. This is a 45 day notice as per Code of Ala. §39- 1-1, paragraph (b) of which provides: “In the event the surety or the contractor fails to pay the claim in full within 45 days from the mailing of the notice, then the person or persons may recover from the contractor and surety, in addition to the amount of the claim, a reasonable attorney’s fee based on the result, together with interest on the claim from the date of the notice.”

The statements and matters within this Notice are alleged upon information and belief.

State of
County of

On the date indicated to the right of this verification, _______________________, Agent for Claimant, and represented by _____________________________, personally came and appeared before me, and voluntarily executed this instrument in the agent’s stated capacity. The deponent says that s/he has read the foregoing notice of claim on bond and knows the contents thereof, that as the appointed agent for the Claimant the deponent has been provided the information indicated in this notice, and that the same is true upon the deponent’s information, knowledge and belief.

 

Notary Public

 

 

Signed this ____ day

of _________________, 20____.

 

 

Claimant

Signed by
Title:

PROOF OF SERVICE AFFIDAVIT

I, __________________________, being duly sworn, deposes and says that I am over the age of 18 years old, and that on the _____ day of _____________, 20____, I served the attached Notice of Claim on Bond to the following parties at these stated addresses:

[______]   Surety

[______]   Hiring Party

[______]   Prime Contractor

[______]   Hiring Party

I served the attached document:

[______]   By personally delivering the notice to the identified parties;

[______]   By First Class Certified Mail service, return receipt requested, postage prepaid.

State of
County of

Sworn to and subscribed before me, undersigned Notary Public, on the date inscribed to the right of this verification.

 

Notary Public

Signed this ____ day

of _________________, 20____.

 

Claimant

Signed by
Title:
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