CLAIM ON PAYMENT BOND

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LIEN UTAH LLC

P.O. Box 171053
Salt Lake City, Utah 84117
801-272-0912 (o)
801-273-1061 (f)
order@lienutah.com

Autofill

CONSTRUCTION ORDER FORM 4 - CLAIM ON PAYMENT BOND

(Used To Prepare a Claim Against a Payment Bond by those Furnishing Materials, Labor, or Equipment to Improve Utah Property)

IDENTIFY THE ENTITY MAKING THE CLAIM (I.E. YOUOR YOUR COMPANY):

DESCRIBE THE SERVICES YOU FURNISHED:

IDENTIFY YOUR PRELIMINARY NOTICE:

Did you file a Preliminary Notice (i.e. a Pre-Lien) on the Utah State Construction Registry?

Yes

IDENTIFY THE PROPERTY THAT HAS BENEFITTED FROM YOUR LABOR, EQUIPMENT, OR MATERIAL:

IDENTIFY THE OWNER OF THE PROPERTY (IF KNOWN):

IDENTIFY YOUR CUSTOMER (THE PERSON OR COMPANY YOU CONTRACTED WITH):

IDENTIFY THE SURETY COMPANY THAT ISSUED THE PAYMENT BOND:

SPECIAL INSTRUCTIONS

TERMS: The entity on whose behalf this preliminary notice is being filed (“Customer”) hereby appoints Lien Utah LLC as its agent for the limited purpose of preparing and filing the preliminary notice requested herein. Customer warrants that it has the right to file this preliminary notice and covenants to indemnify, defend (with counsel chosen by Lien Utah LLC), and hold harmless Lien Utah LLC, and its agents, successors and assigns, against any and all claims brought against Lien Utah LLC arising from the notice. Customer understands and agrees that Customer’s sole and exclusive remedy against Lien Utah LLC for any damages, including direct, indirect, or consequential damages, arising from the preliminary notice or the performance of the services requested herein is limited to a refund of the amount paid to Lien Utah LLC for the services requested by Customer in this order form. Customer warrants that the information provided herein is true and accurate. If Lien Utah LLC is asked to provide trial or deposition testimony, sworn declarations, or other evidence, it will be paid $40 per hour for the time incurred. The undersigned warrants that he/she is duly authorized to order this notice on behalf of Customer and does so with its authorization. Customer agrees to promptly pay for the requested services upon receipt of an invoice. If payment is not made within 21 days of the invoice date, Customer will pay interest at the rate of 2% per month from the invoice date on all amounts owed. Customer will pay Lien Utah LLC’s attorneys’ fees and costs incurred in enforcing these terms.    Prices assume one property owned by persons residing at one address.  An additional $10 will be charged for each additional property included in the same notice and for each additional owner address to which the notice is served.  Prices assume customer will provide complete and accurate information.  If not, an additional charge will be assessed commensurate with the above charges for additional properties/owners and for any additional time needed to obtain the missing information.

Signature (a typed signature functions as a written signature)

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