Laserfiche WebLink
Final Waiver of Lien <br />State of Indiana, County of St. Joseph SS: <br />..� �... <br />Dustin Hilary_ being duly sworn that be/sheisthe South Bend Area Vice President <br />(Name ofOfflco-r) ((7title <br />Of Walsh &Kelly, Inch havIugcontracted With City of South Bend <br />(Contractor) <br />(Owner) <br />tofumishcertain_materialsanftrlabor asfollows-, Asphalt Pavement, Concrete and Marking <br />(Description) <br />for aprojectlmownas # 117-0§ 4._Marriott Hotel Site Development at Hall of Fame, Phase 3, Bid A & B <br />(Name of Project) <br />located at 121 South Dr. Martin Luther King Jr. Boulevard, South Bend, IN 46601 <br />and owned by City of South Bend <br />(Owner)...._�___............._................�..,�..___��� <br />and does hereby further state on the behalf oftho aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />__........ .. ,. ,,.__ ..__..�._._ Dollars <br />❑ recolpt of which is hereby acknowledged; or <br />❑ the payment ormileh has been promised as the sole consideration for this AffidAvlt and Phan "iiV"alver ol'Llen-wvh;iob is given <br />sololy withrospect to said entoua�wt, oad which waiver sbah be oflootive only ppun receipt ofpaym otat thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due $om the contractor is the stun of 11,091.53 <br />❑ receipt of which is hereby aolmowledged; or <br />G <br />21 die payanont of which has been proroiscd as the sale consideration for this Affidavit and Final Waiver of Lien which shall <br />become offective only upon receipt of such pgmont. <br />71MUFOI. M, the undersigned waives and releases canto tite Owner of said promises, any and all liens or claims whatsoever <br />on ttto nbove,-desrribcrl prop(,tty acid linprovemem thereon an aceetaut of labor or material or both, furnished b the undersigned <br />thereto, subject to limitations or conditions oxprossed hcreln if any; and fUrthereaartified the no other party has any claim orrightto a <br />Ilea on account of any work p rfoaued or ivaterial WL <br />ioi9 ndevglgnodt for sa d 15i: Oct, a w the scrape of (bis Affidavit <br />and Walver of ion. NN t), <br />"w �«............ <br />�, <br />Walsh4& Kelly Inc. �' .,w <br />pt�rta Am iRA <br />d Representative) <br />STATE OF INDIANA —• <br />) SS: <br />ST, JOSEPH COUNTY ) � <br />Defore me the undersigned, a Notary l�t e, ins " � ($6ty and State, personally appeared D u sti n H i I a ry <br />and acknowledged the executionf the foregoing I& r of Lion. <br />December) hereunto sins my name g and affixed my offici seal on t ate day of <br />IN WITNESS WM. O.ol: Ihave "' e .�. 21 <br />200 <br />Noutry Public Signature <br />My Commission Expires: June 07, 2023 <br />aaeurpn <br />Residingin Indiana Coun Amy Elizabeth Ti <br />ty, .�, Marshall_.w�.__�..... � <br />�,MY W2 <br />at 111d9 aaa <br />�� �wti�� ati,aGi �eurat� <br />r.�Conim Titan xp4e$ ' <br />.luaae 7, 2,023 <br />