CERTIFICATE OF FINAL COMPLETION
Commonwealth of Massachusetts
Executive Office of Housing and Livable Communities	This form should originate with the Design Consultant
				
Contractor	Contractor Name		Owner:	City or Town	Housing Authority	
	Contractor's Street			LHA Street	
	Contractor City State Zip			LHA City, State Zip	
Phone	     		Phone	     	
Fax	     		Fax	LHA’s Fax       	
Development No	     		Period Ending	     	
Contract for:	     		FISH No;	     	
					
The parties Agree that the Status of the Contract is as follows:	
I.  Contract Time			
1.  The Date of Substantial Completion is			     		
2.  The Date of Substantial Completion as Extended by Change Order is			     		
3.  The Actual Date of Substantial Completion is:			     		
4.  Overrun in Contract Time  			     		
II.  Contract Sum				
1.  The Original Contract Sum is		$	     		
2.  The Sum of Approved Change Orders to Date is		$	     		
3.  The Adjusted Contract Sum is		$	     		
Less:				
4.  Sum of authorized payments to date:		$	     		
5.  Sum of other claims by Owner:		$	     		
III.  That Application for Payment No.	   	is due & payable in the amount of:	$	     		
Copy Attached			
			
The Undersigned Contractor hereby certifies that:   The Contractor should complete items 1-5 and certify below	
1.	All Work, including work required under change order(s) 	     	has been performed in accordance with the terms of the Contract.	
2.	All changes to the Work (except minor modifications and field adjustments) have been authorized in writing by the Owner.	
3.	All laborers and mechanics have been paid at least the minimum wage rates as set forth in the Contract, and	
4.	There have been no claims made for infringement of any patent.	
5.	By accepting the payment shown in line III the Contractor releases the Owner from any and all claims arising under the Contract.	
Certified: Contractor	
In witness Whereof the Undersigned has signed and sealed		Subscribed and Sworn before Me this ___  day of ________  200	
this Instrument this 		day of		  200			
Firm:	     				
By:  		Date:			Notary	
			
Title:			My Commission Expires	

Certification of Housing Authority Board Vote:	
				
The	     	Housing Authority met on 		And voted to approve this Certificate and Payment	
				
Certified:		Contract Officer	

Approved:  Design Consultant	Reviewed:  Construction Advisor 	Approved: Director Const. Management Unit	
Firm:     	Executive Office of Housing and Livable Communities	Executive Office of Housing and Livable Communities	
			
By:	By:	By:	
Date:	Date:	Date: