Yukon Form Yg 3747Q F1 – Fill Out and Use This PDF

	STATUTORY DECLARATION
Highways and Public Works	CERTIFICATE OF SUBSTANTIAL PERFORMANCE

IN THE MATTER OF a contract bearing No.

between the Government of the Yukon and

(Insert full name of Contractor) (the “Contractor”)

for

(Description and location of work)

dated the

day of

, 20

AND IN THE MATTER OF the Certificate of Substantial Performance of the Work relating thereto.

TO WIT:
I,		of
	(Print or type full name of declarant)		(Declarant’s Address)
do solemnly declare:

(1) I am

(Print or type Declarant’s title or position with the Contractor or state that the Declarant is the Contractor)

and as such have a personal knowledge of the Contract and of the facts and matters declared herein, said personal knowledge resulting from, among other things, an examination of the books and records of the CONTRACTOR;

(2)The terms “CONTRACTOR”, “CONTRACT PRICE”, “OWNER” and “THE WORK” have the meanings assigned under the Contract;

(3)With the exception of a maximum 10% Progress Payment Holdback and a maximum 5% Warranty Holdback from each supplier of labour or materials used in the performance of THE WORK which the CONTRACTOR is lawfully entitled to withhold, whether or not such material supplier or labour supplier is an approved supplier or subcontractor under the Contract, all claims for labour and materials of such suppliers of labour and materials against the CONTRACTOR on account of THE WORK have been paid;

(4)With the exception of wages not yet due, all employees of the CONTRACTOR for labour supplied on account of THE WORK have been paid;

(5)This CERTIFICATE OF SUBSTANTIAL PERFORMANCE OF THE WORK is submitted under the terms of the CONTRACT in order

to allow funds to be paid by the Government of the Yukon to the CONTRACTOR.

And I make this SOLEMN DECLARATION conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath and by virtue of the CANADA EVIDENCE ACT.

A Notary Public, in and for the Yukon Territory.

(Please clearly state authority for receiving solemn declarations)

NOTICE

If this Declaration is not complete in every detail, it will be returned for completion and payment will be delayed.

YG(3747Q)F1 Rev.08/2002