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Project Completion Affidavit - Douglas Landscape Inc - 2016 Tree Planting Project No 116-031
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Project Completion Affidavit - Douglas Landscape Inc - 2016 Tree Planting Project No 116-031
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4/1/2025 2:51:56 PM
Creation date
11/16/2017 12:40:43 PM
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Board of Public Works
Document Type
Projects
Document Date
11/14/2017
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Final Waiver of Lien <br />State of Indiana, CountySS, <br />�of �0 S <br />.DO l�l mo. n being duly sworn that he/she is the r 5 <br />en <br />(blame of Officer) I (Title) <br />Of -DOM (a-S La-^d1; havingcontractedwith e. —80-F 7 <br />(Contractor) (Owner) <br />to fhmhh certain materials andlor labor as follows: <br />for a project known as <br />located at <br />and owned by <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars ($ - ) <br />❑ receipt of which is hereby acYnaowlodged; or <br />the payment of which has boon promised as the sole consideration; for this Affidavit and final Waiver of Lien-whloh is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the dal balance due Rminx the contractor Is the start of <br />❑ receipt ofwhieh is hereby aclmowledged; or <br />❑ the payment of which has been promised as the Sole consideration for this Affldavlt and Final Waiver of Lien which shall <br />become effective only uponreceipt of such payment. <br />TFIBREFORE. the undersigned waives and releases unto the Owner of said promises, any and all liens or claims whatsoever <br />on tho above-deserlbed property and improvements thereon an accouc,t of labor ormiltarial or both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herela, if any; and further certified that no other party has any claim or right to a <br />lion on account of any workperfonned or material famished to the undersigned for said project and within the scope oftbis Affidavit <br />and WaiverofLien. <br />(Firm) (Authorized Repres tutive) <br />STATE OF MIANA ) <br />SS; <br />ST. YOSSPH COUNTY ) <br />Before me, the undersigned, a Notary Public, In and for sold County and State, personally appeared Wit, tirn/� n <br />and aekltowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS W03REOF, I have hereunto subscribed my name and affixed my official seal on the a?M h day of <br />SU 1W 2091 <br />Noey Publff Signature k� <br />MyCommission Expires: ao_ ! <br />R$slding in 5-� . �p 5� County, �� �,�, n � -f� L . � GI'� wifi Z, <br />1ENNIFER L SCHULTZ <br />.NOT::iiY PUBLIC - OFFICIAL SEAL <br />Slato of Indiana, St. Joseph County <br />My COMM, Expires September 27, 2019 <br />
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