DOT Limited Liability Company (LLC) Lien Filing

Limited Liability Company (LLC) Lien Filing

South Dakota Department of Transportation

1. Company Filing Lien:

2. DOT Project Number:

County:

3. Prime Contractor:

4. Subcontractor (if you are a second-tier sub or supplier):

5. Type of Work Performed:

6. Materials Supplied:

7: Dates Work Performed:

8. Balance Due:

9. Signature:

________________________________ [affix Corporate Seal if available]

10. Title:

________________________________

11. Date:

________________________________

On this the ____ day of ____________ , 20___ , before me, __________________________________ ,

a notary public, personally appeared ___________________________, who acknowledged himself/herself to be the ___________________________ of _____________________________________________, a limited liability company, and that he/she, as such officer being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the limited liability company by himself/herself as such officer.

In witness whereof I hereunto set my hand and official seal.

Signature of Notary Public:________________________________

State of:________________________________

(Notary Seal)

Residing at:________________________________

My commission expires:________________________________

Instructions for a Limited Liability Company (LLC) Filing a Lien

Company requesting a lien.
DOT project number: The South Dakota Department of Transportation (DOT) project number [such as BRO 8042(2)] of the project for which you are owed money. Complete a separate lien filing form for each project that you are owed money. County: The county or counties the project is located in.
Prime contractor: self-explanatory.
Provide name of subcontractor only if your company worked under that firm as a second-tier subcontractor or supplier.
Provide a brief description of work your company provided, but was not paid, such as -- hauled 50 tons of gravel from crusher to project; seeded 10 acres; installed 150 ft of three cable guard rail.
Materials supplied: Provide a list of materials you supplied by type and quantity or weight.
Provide a list of the dates your company performed the work or supplied materials your company was not paid for.
Provide the balance of the money due to your company for services or materials provided.
Signature of the company’s duly authorized representative or majority owner and affix the company’s corporate seal (if available).
Title of duly authorized representative or majority owner authorized to sign form on behalf of the company.
Date the form was signed.
The lien must be notarized.
Retain a copy of the lien filing for your records.
Liens are to be filed only for projects where payment is due from the DOT. The DOT does not have authority to file a lien on projects let by another department or governmental entity.
This lien filing will withhold an amount of money sufficient to cover the lien from funds due or to become due to the prime contractor.
Action to enforce or determine the validity of the lien may be brought by the claimant, the contractor, or the DOT in the Circuit Court for the county where the work or any part will be situated.
This lien will cease to have any validity or be binding on the contractor or DOT unless an action to enforce the same is commenced within thirty (30) days from the acceptance of the work for which the same is claimed.
Notwithstanding these instructions, the provisions of SDCL Chapter 5-22 govern liens relating to public improvement contracts.
Mail original signed and notarized form to:
Department of Transportation - Office of Legal Counsel
700 East Broadway Avenue
Pierre, South Dakota 57501-2586