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Fb alWaivex ofLien <br />State of Indiana, County of St. Jose ii SSt <br />Joshua A. McCormick: being duly sworn that he/she Is the Sales Manager <br />(Name of Officer) (Titio) <br />of Rieth-Riley Construction Co. Inc. having coratractedwith, City of South Bend <br />(Contractor) (Owner) <br />toy" vishcertnia materialsand/or labor asfollows; Milling and asphalt overlay <br />(iyescrlption), <br />for a pr(� ca kiLown as Downtown, Mill and Asphalt Overlay <br />(Name of Project) <br />located at South Bend, Indiana <br />and owned by City of South Bend <br />and does hereby flu-thor state on the behalf ofthe, aforementioned sarbcontractor/sapplier: <br />(PARTIAL WAMR) that there is date f om the Conteactor the sure of <br />Dollars ( ) <br />El receipt of wliioh is hereby acltnow1cdgcd; or <br />[f die payment of which has been promised us the sole consideration for flan Afhdavlt and Final Waiver ofLienlvhich is given <br />solely with respect to saki aniounu and which waiver shall be effective only upon receipt of payment thereo£by tho <br />undersigned, <br />(KNHundred <br />w <br />VFI�.) that the inial balance drat £corn the contractor is the stem. of <br />Two Hu n dred & Five Thousand Eight Hundred Twenty Five 28/1p __._._ ) $208,825.25 <br />E] reoelpt of which is hereby neianowledg-W; or <br />5d the payment ofwhichhas beenpromisW as the solo consideration for this Affidavit andl'inal Walvor ofLien which shall <br />become offeedve ont"ponxecelpt of such payment, <br />"iTIII FFUIE, the undersigned waives and releases wrto ilio owarer of said premises, any and all liens or claims whatsoever <br />oft tho above-descrlbcdproperty and improvements thereon art accoiwt of labor or material or both, Airnishod b the undersigned <br />thereto, subject to liriaitations or conditions expressed herein, if any; and farther certified that no other party has any claim or rii htto a <br />Pon on acoonat of any work performed or material furnishQd.to the undersigned forsaldproject, and wltbinthe svope of thisAffildavit <br />and Waiver ofLi r. <br />Rieth-Riley Construction C6., Inc. By <br />v� <br />(Finn) (aattlroram gro-sontative) <br />STATE 01 INDIANA ) <br />SS; <br />ST, JOSFPII COUNTY ) <br />Before me, die a Notary Public, in grad for said Coamty and State, personally appeared Joshua A. McCormick <br />and nokrrowledged time execution of the foregoing Affidavit and Waiver of Mom 16th� <br />IN WITNESS WMREOF, Ihavchercunto subscribed my name and affixed my official seal on the day of <br />February, 2018 :200 <br />" ;NotaayPrablicSigriadina <br />My Commisslon.13 Fires; 10/22/22 <br />Sue Anne Cira <br />Residing in St. Joseph - county, Indiana <br />SUE ANNE { <br />Notaryp % if Indiana <br />st Joseph <br />County <br />