Lien Assurance Form : Strategic Outsource Solutions

Your Information

Name*

First Last

Company Name*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Your account name

Your account number

Amount of claim

Job type

Public
Private

Project Information

Job site name

Job site address

Street Address Address Line 2 City State ZIP Code

Owner name

Owner address

Street Address Address Line 2 City State ZIP Code

General contractor name

General contractor address

Street Address Address Line 2 City State ZIP Code

Sub-contractor name

Sub-contractor address

Street Address Address Line 2 City State ZIP Code

If the job is bonded? If yes please e-mail bond to vingold@commercialcollection.com or fax to 800-873-5211.

If you have notice of commencement, please e-mail to vingold@commercialcollection.com or fax to 800-873-5211. (if applicable)

Sales Information

Project manager name

First delivery date

Last delivery date

Sales Information

Choose all that apply

File lien
Send pre-lien notice
Obtain copy of bond and verify coverage
Investigate lien potential
File bond claim
Tracking

Use the section below to upload e-mail invoices/statements. If you have more than 4 files, please email them to vingold@commercialcollection.com.

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

Additional Comments

If you have any questions at all, do not hesitate to call Valerie Ingold at 800-873-5212 ext 256 or e-mail vingold@commercialcollection.com.

Disclaimer of Liability

It is understood and agreed that CCC of New York wil use its best efforts to serve or file the above requested document and that CCC of NY is providing its services through sources it deems to be reliable. CCC of NY shall not be responsible or liable for claims for damages for any reason whatsoever, including claims for special, punitive, incidental or consequential damages, or claims for lost profit.

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