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AFFIDAVIT AND WAIVER OF LIEN <br />❑ Final ❑ Partial ❑ Payment to Follow <br />STATE OF: Indiana <br />COUNTY OF: St. Joseph <br />Jennifer Brown being duly sworn, deposes and says that __he makes this <br />affidavit for and in behalf of MARTELL ELECTRIC, LLC which, having entered into an agreement with <br />of South Bend ("Contractor") for the construction of 2016 Traffic Calming Solar Speer <br />Indicators Proj # 116-035 on the premises of the owner located at South Bend IN <br />states that, upon receipt of payment by Martell Electric from Contractor in <br />the amount of Twenty seven thousand three hundred twelve & no/100 —Dollars, <br />(the "Payment"), which payment has been promised by Contractor and is anticipated by Martell Electric, <br />all material and subcontract, due and payable, will have been paid and all labor paid in full to the date of <br />this affidavit EXCEPT for: <br />RETENTION $ <br />$ <br />Effective upon receipt by Martell Electric of the Payment, Martell Electric does waive and release unto the <br />owner of said premises, any and all lien, right of lien or claim of whatsoever kind of character on the <br />above -described building and real estate under the Statutes of the State of Indiana <br />relating to Mechanic's liens, on account of any and all labor, material, or both, furnished for or <br />incorporated into said building by the undersigned, up to this date. <br />MARTELL ELECTRIC, LLC <br />BY <br />(Signed) <br />Jennifer Brown <br />(Printed Name) <br />Vice -President <br />(Title) <br />Subscribed and sworn to before me, <br />on this 3rd day of March, 2017 <br />1 dA.�- �— <br />Notary Public <br />�P�......�i�eng4 <br />J s .' <br />NotarRENAicBALDe of Indiana <br />.,,ouvr'.. = <br />-'�' "�-'�O <br />St Joseph County <br />Commission 8 663664 <br />My commission expires: 2/28/2023 <br />n SEAS! <br />y <br />My Commission Expires <br />February 28, 2023 <br />