Please prepare for our representative's signature a Notice of Performance and Non-Payment Lien in accordance with the following information:
Date of first furnishing of materials or labor to job-site: (Fecha De Primer Dia Del Projecto)
Date of last furnishing of materials or labor to job-site: (Fecha De Ultimo dia Del Projecto)
Our direct customer is:
The nature of the service, labor and/or materials furnished by us at the job site was: (Materiales y Servico echo en el projecto)
Total value of what we furnished (Note: Do Not include work Not done) (Valor final de/ Contrato?) $
Balance owed for what we furnished (Balance de la deuda de trabajo serviciado?) $
Retainage $
This was under:One Contract (Projecto bajo Un Contrato?)Multiple Contracts (Projecto dividido en Varios Contrato?)
Job Name, Address include City & Zip and Legal Description (Nombre De Projecto y direccion)
Notice to Owner was served as follows: or our NTO# (Submitir copia Del NTO o Aplicar # de documento)
Served On:
Owner: (Dueno De propiedad)
Owner Address include City & Zip:
Contractor:(Contratista General)
Contractor Address include City & Zip:
We hereby certify that the above described materials were used, or labor and services were performed, in the improvement of the real property name above; that no waiver and the above stated information is true and correct. (Atraves de este documento, rectifico y confirmo que las materials utilizado, Labor y servicios rendidos y declarados en este documento, fueron utilizados en el projecto en este documento. Y confirmo que la informacion declarada es verdad y correeto.)
Our Firm Name: (Nombre De Compania)
Firm Address include City & Zip: (Direccion)
Firm Phone: (Numero De Contacto)
Firm Email:
Person (President or Vice President) to Sign the NNP:
Electronic Signature
Your Email
You will receive an email confirmation of this submission. If you do not - Please call or fax or email pcncorp@gmail.com PHONE: 954.583.5525 FAX: 954.771.0925 When done, please:
