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WAIVER OF LIEN <br />1. The undersigned labors, mechanics, materialmen, suppliers, contractors and/or subcontractors ("Undersigned") entered into an <br />agreement ("Agreement") with the City of South Bend ("General Contractor") to furnish labor, services, materials, <br />and/or specially fabricated materials, etc., for the construction, improvement or repair of House Demolitions Proiect 115- <br />12E Ph. S ("The Project") located in the City of South Bend County of St Joseph , State of Indiana <br />2. In consideration of $ 7,296.50 and other good and valuable consideration, the receipt of which is hereby acknowledged, the <br />Undersigned hereby waives and releases to the extent of such payment and in accordance with the terms contained in paragraph 3 <br />below any mechanic's or materialman's lien or personal liability claims, public works claims and claims against any payment or <br />performance bonds, or claim or right of such lien on the above -described premises and on improvements now or hereafter located <br />thereon and which now exist or might otherwise arise because of labor, services. Or materials famished or to be famished by the <br />Undersigned pursuant to the Agreement, <br />3. This lien waiver is a partial or final waiver and release of lien as provided below: (Check One) <br />_ Partial release and waiver of lien <br />X Full release and waiver of lien <br />If this waiver of lien represents a partial waiver or release of lien, the amount of the unpaid balance due is <br />4. The Undersigned certifies that the materials and/or work covered by this application have been furnished in accordance with the <br />contract documents, that all amounts have been paid by him for materials and/or work for which previous monies were paid, and the <br />current payment shown herein is now due. <br />5. I have executed this waiver voluntarily and with full knowledge of my rights under the laws of the State of Indiana. The <br />Undersigned is fully authorized to execute this document on behalf of the business so named. <br />Given this 25th day of May , 20 16 . <br />Mark Osler. President <br />(Name & Title of Authorized Signer) <br />STATE OF: Indiana <br />COUNTY OF: St. Jospeh <br />Signed and sworn to before me by Mark Osler this 25th day of May 2016. <br />(NOTARYSEAL) Z,4�- <br />Signature: <br />Printed: Keith Stevens <br />(Notary Publ <br />My Commission Expires: 10/15/2023 <br />County of Residence: Elkhart <br />