Change Order No. 3 (final)-PCA - Demo of Vacant & Abandoned Houses Phase IX Project No 116-074A - Indiana Earth, Inc.

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WAIVER OF LIEN 1. The undersigned labors, mechanics, materialmen, suppliers, contractors and/or subcontractors ("Undersigned") entered into an agreement ("Agreement") with the City of South Bend ("General Contractor") to furnish labor, services, materials, and/or specially fabricated materials, etc., for the construction, improvement or repair of House Demolitions Proiect 116 — 704A Phase 9 ("The Project") located in the City of South Bend County of St Joseph , State of Indiana 2. Inconsideration of $ 40,685.00 and other good and valuable consideration, the receipt of which is hereby acknowledged, the Undersigned hereby waives and releases to the extent of such payment and in accordance with the terns contained in paragraph 3 below any mechanic's or materialman's lien or personal liability claims, public works claims and claims against any payment or performance bonds, or claim or right of such lien on the above -described premises and on improvements now or hereafter located thereon and which now exist or might otherwise arise because of labor, services. Or materials famished or to be famished by the Undersigned pursuant to the Agreement, 3. This lien waiver is a partial or final waiver and release of lien as provided below: (Check One) Partial release and waiver of lien X Full release and waiver of lien If this waiver of lien represents a partial waiver or release of lien, the amount of the unpaid balance due is 4. The Undersigned certifies that the materials and/or work covered by this application have been famished in accordance with the contract documents, that all amounts have been paid by him for materials and/or work for which previous monies were paid, and the current payment shown herein is now due. 5. 1 have executed this waiver voluntarily and with full knowledge of my rights under the laws of the State of Indiana The Undersigned is fully authorized to execute this document on behalf of the business so named. Given this 6th day of December , 2016 ..... .tie .Z Y 0. SEAL��a�a, �'Pi '��OSEPH G"; •' ��? 16 - STP�� STATE OF: Indiana COUNTY OF: St. Joseph 0 (Authorized Signature) Mark Osler. President ' (Name & Title of Authorized Signer) Signed and sworn to before me by Mark Osler this 6th day of December 2016. (NOTARYSEAL) My Commission Expires: 08/18/2024 County of Residence: St. Joseph Signature: A�12J4�L Printed: Melissa Blair Oiler (Notary Public)