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Change Order No 2-PCA - Great Lakes Capital Spec Building Paving Project No 118-058 - Walsh & Kelly Inc
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Change Order No 2-PCA - Great Lakes Capital Spec Building Paving Project No 118-058 - Walsh & Kelly Inc
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4/7/2025 11:04:59 AM
Creation date
7/24/2019 1:26:42 PM
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Board of Public Works
Document Type
Projects
Document Date
7/23/2019
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Final Waiver of Lien <br />State of Indiana, County of _ it. -J e l SS: <br />Dustin Hilaryg dui Area Vice President being y sworn that he/she is the South Bend <br />erne of Officer) (Tide) <br />of Walsh & Kelly, Inc.th...... <br />having contracted with j!K —m_'Git_ Of South ._Be nd <br />(Contractor) (Owner) <br />to liirnish ceitaln materials and/or labor as follows; s halt Payinq and Concrete Work <br />(Description) <br />for a project known as Greatp p g Lakes Capital Spec Building <br />(Name of Project) <br />located at � 5545 Chet goner Court, South Bend, +I�It of South Bend Indiana IN 46628 <br />_ & KEG <br />and owned by y <br />and does hereby Author state on the behalf of the aforementioned subcontractor/supplier: — G r� <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of «« SEAL <br />Dollars �� _d�� <br />�4t1'111111111N <br />❑ receipt of which is hereby aclaiowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which 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) ..�w"._.,..�_.. that the final balance due kom the contractor sum of 132: 68008 the .. <br />❑ receipt of which is hereby acknowledged; or <br />® the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of said premises, in end all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material orb ,1hruished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified a other rty has any claim or right to a <br />lien on account of any work performed or material famished to the undersigned for ,Icct ei !thin the scope,ofthi's Affidavit <br />and Waiver of Lien. r 17 <br />Walsh & innKInc. B��F) utlaot°i rl Ipresrzttivci <br />STATE OF INDIANA ) Lin Hilary, South Bend Area Vice President <br />SS: <br />5T, IOSEPH COUNTY <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally a peared Dustin Hilary <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. 25th <br />IN WITNESS WHEREOF, I have hereunto subscribed my na and affixed myofficiat on the day of <br />June 200 <br />My Commission <br />e_ <br />....._. r23 <br />Elizabe <br />Rosldin im Marshall county, Indiana _y th Tur in <br />wa <br />N! "°IC'na c�i Griddana <br />a:u�ty E�uees�Cl�' <br />
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