CSI DIVISION 00 65 19 · STATUTORY MECHANICS LIEN & CLAIM RELEASE
General Commercial Safe-Harbor Statutory Standard
NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT.
Name of Claimant:
Apex Commercial Mechanical LLC
Name of Customer (Hiring Party):
Turner Construction Company
Job / Project Description:
Vanderbilt Health Center Tower (Phase II - Job #2026-88)
Property Owner:
Vanderbilt Medical Plaza LLC
Physical Job Location / Address:
450 11th Ave N, Nashville, TN 37203 (Davidson County)
Payment App / Period:
Pay App #04
Amount of Payment:
$84,500.00
Through-Date (Cut-off):
September 30, 2026
Maker of Check:
Turner Construction Company
Check / Wire #:
CHK #98421 / EFT
Drawn on Bank:
JPMorgan Chase Bank, N.A.
EXCEPTIONS / CLAIMS RESERVED FROM THIS WAIVER & RELEASE:
DOES NOT COVER DISPUTED AMOUNTS
Contract 10% Retainage ($9,388.89), Pending Change Order Request (COR) #02 ($14,200.00 for Duct Routing Revisions), and Unapproved Differing Site Condition Claim.
Claimant Representative Execution:
Marcus Vance
Marcus Vance, Managing Executive
Duly Authorized Representative of Claimant
Date of Execution:
September 24, 2026
Subcontract / Reference #: SC-2026-23-004
Claimant License: TN-CMC-B #00078491
SWORN JURAT & NOTARIAL ACKNOWLEDGMENT
State of Tennessee
County of Davidson
[Official Notary Seal / Stamp Required]
Affix Seal Here
Subscribed and sworn to (or affirmed) before me on this ______ day of ____________, 20____, by Marcus Vance, proved to me on the basis of satisfactory evidence to be the person who appeared before me and executed this statutory instrument.
Signature of Notary Public
11/14/2028
My Commission Expires
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