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WAIVER OF LIEN <br />1. The undersigned labors, mechanics, materialmen, suppliers, contractors and/or subcontractors ("Undersigned") entered into an agreement <br />("Agreement") with the City of South Bend ("General Contractor") to famish labor, services, materials, and/or specially fabricated <br />materials, etc., for the construction, improvement or repair of House Demolitions Project 116 — 074C Phase 9 ("The Project") <br />located in the City of South Bend County of St Joseph , Stale of Indiana <br />2. Inconsideration of$ 4580.29 and other good and valuable consideration, the receipt of which is hereby acknowledged, the Undersigned <br />hereby waives and releases to the extent of such payment and in accordance with the terms contained in paragraph 3 below any mechanic's or <br />materialman's lien or personal liability claims, public works claims and claims against any payment or performance bonds, or claim or right of such <br />lien on the above -described premises and on improvements now or hereafter located thereon and which now exist or might otherwise arise because <br />of labor, services. Or materials furnished or to be furnished by the 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 />Pa ual release and warver of lien <br />X Full release and warver 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 famished in accordance with the contract <br />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 <br />herein is now due. <br />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 <br />authorized to execute this document on behalf of the business so named. <br />Given this 6th day of December , 2016 <br />Mark Oster. President <br />(Name & Title of Authorized Signer) <br />STATE OF: Indiana <br />COUNTY OF: St. Joseoh <br />Signed and sworn to before me by Mark Oster this 6th day of December 2016. <br />(NOTARYSEAL) DA <br />Signature: ✓Q Lir1i <br />Printed: Melissa Blair Oster <br />(Notary Public) <br />My Commission Expires: 08/182024 <br />County of Residence: St. Joseph <br />