Change Order No. 3 - Project Completion Affidavit - Calvert Street Lift Station Replacement Project No 116-053 - HRP Construction Inc.

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Final Waiver of Lien STATE OF INDIANA, as: Whereas, the undersigned HRP CONSTRUCTION INC. has been heretofore em- ployed by City of South Bend Board of Public Works to furnish certain material and labor, to -wit: Calvert St. Lift Station Replacement, Project No. 116-053, St. Joseph County, Indiana for the property owned by City of South Bend and located on Calvert Street City of South Bend , County of St. Joseph , State of Indiana. Now 'I'HrREIi oPE, KNow YE, That the undersigned, for and in consideration of $ 45, 814.42 Dollars, the receipt of which is hereby acknowledged, hereby and now waives and releases unto the said owner of said premises, any and all lien, right of lien or claim of -whatsoever kind of character on the above described building and real estate, TOAND.t OR SAIDAMOUNT, on account of any and all labor material, or both, furnished for or incorporated into said building by the undersigned, up to this date, and they further certify that the consideration moving to the undersigned for executing this FINAL WAIVE of LiFN has been mutually given and accepted as a part payment to or on account of the said Owner for said building and real estate. Signed, sealed and delivered this 16th day of October , 20 17 Signed Nanc Kna ik Personally appeared before me this 16th day of October 20 17 Nancy Knapik who, being duly sworn on oath, says: That he is Controller of the HRP CONSTRUCTION INC. and that he hereby acknowledges the execution of the foregoing instrument far and on behalf of said Corporation and at their special instance and request. My Commission Expires 3/06/24 Vataheste This instrument prepared by: Nancy Knapik Notary Public