This certification comes after periodic inspections of the work site, while work was being done and a final inspection of the completed work on.

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1 CERTIFICATION OF WORK COMPLETED I hereby certify that the contracted work done by on the unit located at, Florida, owned by, has been completed and that the finished work complies with all the attached specifications. This certification comes after periodic inspections of the work site, while work was being done and a final inspection of the completed work on. Rehabilitation Specialist Date I, the undersigned homeowner, have inspected all contracted work and certify that the work was completed on the above stated unit and that the finished work complies with all attached specifications. Homeowner Date I, the undersigned contractor, certify that all finished work complies with the attached specifications, the warranty on all materials and equipment has been provided to the, and the instruction sheets for the operation of mechanical equipment given to the homeowner. Contractor 1 Date

2 CONTRACTORS FINAL AFFIDAVIT AND LIEN WAIVER Job Address: Owner Name: Purchase Order: I, the undersigned, herby acknowledge receipt of full and final payment for improvements on the above described property. I hereby waive and lien or right to lien that I may have against the described property. I further warrant to save harmless the property owner and the local government from any liens which are now in existence, or may hereafter arise by reason of said improvements, and cause the same the be released of record immediately. In compliance with the Florida Mechanics Lien Law, I hereby furnish the following affidavit for payment. All just and lawful bills against the improvements at this property for which I have been contracted to perform have been paid (as of ). There are no outstanding liens or claims against said work. Company Name: Signature: Title: Subscribed and sworn before me this day of, 20 in the County of, in the State of Florida Notary Public Print Name Personally Known Produced Identification 2 Type of ID

3 To: Citrus County BOCC WARRANTY FOR REHABILITATION From: Subject Property Address: In connections with the performance of the work under the Contract, you are advised that I warrant that all materials, fixtures and equipment furnished by me (and if applicable) by my subcontractor(s) were new, of good quality and of title, and that all work was performed in accordance with the Contract. Should and defects appear within one year from the date of Final Inspection, which occurred on and should such defects be caused by faulty materials, fixtures, equipment or work, I shall promptly remedy these defects and pay for any reasonable damage resulting therefrom. Contractor Address: Contractor Telephone Number: Signature: Print Name: 3

4 CERTIFICATE OF FINAL INSPECTION Job Address: Contractor: Owner Name: Date of Completion: Date of Final Inspection: Date of Contract: We have conducted a final inspection of the above referenced property. To the best of our knowledge, the rehabilitation work performed on the property in complete and in compliance with the terms of the Contract for Rehabilitation Work. The dwelling now meets all applicable codes and ordinances relating to the property. Signed: Date: Contractor Signed: Date: Housing Services Director Signed: Date: Rehabilitation Specialist 4

5 Contractor Affidavit RELEASE OF LIENS STATE OF FLORIDA COUNTY OF Citrus County Personally appeared before the undersigned attesting officer,, who being duly sworn on oath, has said that he is the building contractor in charge of improving the property owned by, located at. Said contractor claims that all work, labor, services and materials used in such improvements were furnished and performed at the contractors direction; that said contractor has been paid in full at the contracted price; that all work done or materials furnished in making the improvements has been compensated at the agreed price, and that not person has any legal right to claim or lien against the owner by reason of said improvements. Attesting Officer Position Company STATE OF FLORIDA COUNTY OF Citrus County I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and County aforesaid to take acknowledgements, personally appeared Who is personally known to me or provided as identification and who did take an oath. WITNESS my hand and official seal this day of, Notary Public State of Florida

6 SUBCONTRACTOR AFFIDAVIT, WARRANTY AND LIEN WAIVER Contractor: Owner: Job Address: Legal Description: I, the undersigned, do depose and say that I was employed to furnish labor or engaged to furnish materials for an improvement being situated on certain real estate in the State of Florida, as described above. I hereby declare that I have been paid in full for my labor and/or materials supplied for said improvement and I waive any lien or right to lien against the described property. I warranty to save harmless the said property owner and the local government from any lien(s) which are not in existence or may hereafter arise by reason of said improvements. Company Name: Signature: Title: All signatures must be in blue ink Subscribed and sworn before me this day of, in the County of. Notary Public: Print Name: Personally Known: Produced Identification: 6 Type of ID