NOTICE OF NONPAYMENT

     In accordance with the provisions of the bond at issue herein, Section 255.05, Section 713.23, or Section 713.245 of the Florida Statutes, the undersigned , as an authorized agent, hereby gives notice that pursuant to a contract with ________________________________ , the undersigned has furnished the following labor, services or materials:

, the last was furnished on ______________, for the improvement of the following described real property:

, owned by ___________________, on which you are the general contractor. Undersigned has not been paid (or has not been paid in full) and is owed $___________________ dollars of which $___________________ dollars is retainage. In accordance with Florida law, the undersigned is looking directly to you for payment of this amount, and to the surety bond executed to insure payment on said project pursuant to Section 255.05, Section 713.23, or Section 713.245, Florida Statutes or Florida Common Law.

     The undersigned requests a written statement indicating the following: (1) Whether the project has reached substantial completion, as that term is defined in the contract, or if not defined in the contract, if beneficial occupancy or use of the project has occurred; (2) Whether you have received payment of the undersigned's retainage, and if so, the date the retainage was received by you; and (3) Whether you have sent your final payment request to the owner of the project, and if so, the date on which the final payment request was sent. Please provide said information to the undersigned.

DATED _______________________