Project Completion Affidavit - Century Center Mezzanine Project No 118-036R - R Yoder Construction Inc

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AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of Elkhart SS: Randall E. Yoder being duly sworn that he/she is the President (Name of Officer) (Title) of R. Yoder Construction, Inc. having contracted with Qty gf 5gwth Bend, QeD@[Jm@nJ cf PgNig W rks (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: materials and construction for storage mezzanine (Description) for a project known as Centu Center Stora a Mezzanine (Name of Project) located at 120 Dr. Martin L ther Kin r. Blvd South Bend and owned by Ci!y of^South Bend Department nt of Public Works (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum 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 the sum of Five thousand two hundred twelve dollars and eighteen cents $ 5212.1 ❑ 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 become effective only upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens 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 herein, if any; and further certified that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. R. Yoder ConstructionA�nv e Inc. By (Firm) (Authorized R resentative) STATE OF 17IANA ) ) SS: lr'F-4©&BPi+f-#R►1-TY Elkhart ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the My Commission Expires: 05- -2 Residing in Elkhart County, Indiana Randall E. Yoder Notary Public Signature Annette Wiseman Notary Public Name 1 th day of