Project Completion Affidavit - Leighton Parking Garage Entrance Repairs Project No 118-038 - Walsh and Kelly

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AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of St. Joseph SS: Dustin, Hilary being duly sworn that he/she is the South Bend Area Vice President (Name of Officer) (Title) of Walsh & Kelly, Inc. having contracted with Citv of South Bend, Indiana (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: Plpe and Concrete Work (Description) for a project known as Leicihton Gara a Entrance Repair, Project #118-038 (Name of Project) located at Leighton Pair[Kk!inct Garage, South, Bend, IN 46601 and owned by City of South Bend, Indiana (Owner) and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the surn of Dollars receipt of which is hereby acknowledged; or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is (lie stun of Ll receipt of which is hereby acknowledged; or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall became effective only upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, anyand all lions or claims whatsoever on the above -described property and improvements thereon an account of labor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed.4tMIJUripy; and ftirther certified (fiat o other party has any claim or right to, a lion on account of any work performed or materiqkAM*a koeth'i , ersign d e for said ect, and w' hin the scope of this Affidavit and Waiver of Lien, % VORA7',� % Z Walsh & Kelly, Inc, 0, '-Byl 0-- epresentative) (Firm) , kA�'.* _:- STATE OF INDIANA SS: ST. JOSEPH COUNTY 00 ffo it Notary Public, ilblil JjA id County and State, personally appeared Du Before rate, the undersigned, p Hilar 3(_ and acknowledged the execution of the lbregoing, Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed in i cal 0" of September 200 18 WPotry —bffc—, 1—Si My Commission Expires: June 07, 2023 Elizabeth Turpin Residing in Marshall County, Indiana AMY EUAIYPWTORP1 NctM Public, State of Indiana Marshall County Cornmis5ion Expires June 7, 2Q?"