PCA - Ignition Park Identity Signage Proj No 115-103 - Poblocki Sign Co., LLC

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STATE OF WISCONSIN WAIVER OF LIEN TO DATE )SS COUNTY OF MILWAUKEE Gtyk 8936986 Escrow# 201412688.001 TO WHOM IT MAY CONCERN: WHEREAS the undersigned has been employed by CITY OF SOUTH BEND -DEPARTMENT OF PUBLIC WORKS to furnish IGNITION PARK IDENITY SIGNAGE for the premises known as IGNITION PARK of which CITY OF SOUTH BEND - DEPARTMENT OF PUBLIC WORKS is the owner. THE undersigned, for and in consideration of ONE HUNDRED FORTY ONE THOUSAND FOUR HUNDRED THIRTY SEVEN DOLLARS AND 001100 ($141,437.00) Dollars, and other good and valuable considerations, the receipt whereof is hereby acknowledged, do(es) hereby waive and release any and all lien or claim of, or right to, lien, under the statutes of the State of Illinois, relating to mechanics' liens, with respect to and on said above -described premises, and the improvement thereon, and on the material, fixtures, apparatus or machinery furnished, and on the moneys, funds or other considerations due or to become due from the owner, on account of all labor, services, material, fixtures, apparatus or machinery, furnished to this date by the undersigned for the above -described premises, INCLUDING EXTRAS.* DATE: 8.12.2016 COMPANY NAME: POBLOCKI SIGN COMPANY ADDRESS: 922 S. 70Ta STREET MILWAUKEE WI 53214 SIGNATURE TITLE CFO *EXTRAS INCLUDE BUT ARE NOT LIMITED TO CHANGE ORDERS, BOTH ORAL AND WRITTEN, TO THE CONTRACT. ^ STATE OF WISCONSIN CONTRACTOR'S AFFIDAVIT }SS COUNTY OF MILWAUKEE TO WHOM IT MAY CONCERN: THE UNDERSIGNED, (NAME) RICH WACHTER BEING DULY SWORN, DEPOSES AND SAYS THAT HE OR SHE IS (POSITION) CFO OF (COMPANY NAME) POBLOCKI SIGN COMPANY WHO IS THE CONTRACTOR FURNISHING EXTERIOR IGNITION PARK IDENITY SIGNAGE WORK ON THE BUILDING LOCATED AT IGNITION DRIVE S, SOUTH BEND IN 46601 OWNED BY CITY OF SOUTH BEND -DEPARTMENT OF PUBLIC WORKS That the total amount of the contract including extras* is $141,437.00 on which he or she has received payment of $ 0 prior to this payment. That all waivers are true, correct and genuine and delivered unconditionally and that there is no claim either legal or equitable to defect the validity of said waivers. That the following are the names and addresses of all parties who have furnished material or labor, or both, for said work and all parties having contracts or sub contracts for specific portions of said work or for material entering into the construction thereof and the amount due or to become due to each, and that the items mentioned include all labor and material required to complete said work according to plans and specifications: NAMES AND ADDRESSES WHAT FOR CONTRACT PRICE INCLUDING EXTRAS" AMOUNT PAID THIS PAYMENT BALANCE DUE POBLOCKI SIGN COMPANY SIGNS & INSTALL $141,437.0 $ $141,437.0 $0.0 TOTAL LABOR AND MATERIAL INCLUDING EXTRAS* TO COMPLETE That there are no other contracts for said work outstanding, and that there is nothing due or to become due to any person for materitjAor or other work of any kind done or to be done upon or in connection with Isjork other th9p above stated. ,,1.�""''eN' N W 11"014 o`�g�f"".....Nc�� DATE II:I i I I � SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME THIS 27,1 DAY OF Se 4N^ 6w , 20 16 NOTARY PUBLIC My cow"*;sj,sh evp,&s 7Iq/20M %%0 j SEAL: ��'�AVBL%o /" .