PCA - Martin Luther King Jr Center HVAC Revisions Proj No 116-064 - Hermann & Goetz Inc.

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WRA1T Document G706ATM -1994 Contractor's Affidavit of Release of Liens PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: 116-064 OWNER ❑ Martin Luther Ring Jr. Center CONTRACT FOR: HVAC Revisions ARCHITECT ❑ CONTRACTOR ❑ TO OWNER: (Name and address) CONTRACT DATED: September 13, 2016 SURETY ❑ City of South Bend 227 W/ tIefferson Blvd. South Bend, IN 46601 STATE OF: Indiana OTHER ❑ COUNTY OF:St. Joseph The undersigned hereby certifies that to the best of the undersigned's knowledge, information and belief, except as listed below, the Releases or Waivers of Lien attached hereto include the Contractor, all Subcontractors, all suppliers of materials and equipment, and all performers of Work, labor or services who have or may have liens or encumbrances or the right to assert liens or encumbrances against any property of the Owner arising in any manner out of the performance of the Contact referenced above. EXCEPTIONS: NONE SUPPORTING DOCUMENTS ATTACHED HERETO: 1. Contractor's Release or Waiver of Liens, conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subcontractors and material and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. CONTRACTOR: (Name and address) Herrman & Goetz Inc. 225 S. Lafayette Blvd. South Bend, 46601 BY: (,5fgnat'761audjorrzed representative) Larry Cripe, Power—of^Attorney (Printed name and title) Subscribed and sworn to before me on this date: January 16, 2017 /j 1 Notary Public: �` SL/+u/"'-- 11 Catherine . GruberU My Commission Expires: 7/13/2022 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G706ATe —1994. Copyright ®1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This AIAe Document Is protected by U.S. Copyright Lew and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of It, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@ala.org.