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WAIVER OF LIEN <br />X FINAL PARTIAL PAYMENT TO FOLLOW <br />STATE OF: Indiana <br />COUNTY OF: Marshall <br />David J. Delp being duly sworn, states that he/she is the <br />Vice President of Michiana Contracting, Inc. having contracted with <br />City of South Bend to fumish certain materials and/or labor as follows New Traffic rLIR Cameras at Portage, Lamonte <br />and Forest I ntersectionfor a project known as Tratro rue cameras at Portage, Forest and Lamoncyocated at <br />South Bend Indiana owned by City of South Bend <br />and does further state: <br />PARTIAL WAIVER: Thal the balance due from the Owner is the sum or <br />Receipt of which is hereby acknowledged, or <br />The payment of which has been promised as the sole consideration for this <br />affidavit and Partial Waiver of Lien which is given to ad said amount, effective <br />upon receipt of such payment. <br />FINAL WAIVER: That the final balance due from the Owner is the sum of <br />Thirty -One Thousand Dollars and Zero Cents Dollars ($ 31,000.00 <br />Receipt of which is hereby acknowledged, or <br />, X The payment of which has been promised as the sole consideration for this <br />affidavit and Final Waiver of Lien which is given to and said amount, effective <br />upon receipt of such payment. <br />Therefore: The undersigned waives and releases unto the owner of said premises any and all <br />lien or claim whatsoever on the above described property and improvements thereon on account of <br />labor or material or both, furnished by the undersigned thereto, and further certifies that no other <br />party has any claim or right to a lien on account of any work performed or material furnished to the <br />undersigned for said project, and within the scope of this affidavit and waiver. <br />Signed, sealed and delivered this loth day of Au ust, 2016 <br />Signed , Q <br />David J. Delp Al <br />Personally appreared before me this 29th day of August, 2016 <br />David J. Delp who being duly sworn on oath, says: That he/she is <br />Vice President of the Michiana Contracting, Inc. and that he/she hereby <br />acknowledges the execution of the foregoing instrument for and on behalf �f� ""-ii:£stin9, Inc <br />and at his/her special instance and request. <br />Notary Public: <br />ANUREA JAE FISHER <br />Notary Public - Seal <br />State of Indiana <br />Marshall County <br />Commission Expires; March 27, 2022V Resident County: Marshall <br />