Laserfiche WebLink
Final Waiver of Lien <br />State of Indiana, County of St. i O S j h SS: <br />dm� � R • MjLLiLafn..m_._� �__.. being duly sworn that he/she is the e n r 19 <br />(Name of Officer) - (Title) <br />of Peerless-Midwestt. Inc. having contracted with <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows, Procurement, installation of logic controllers <br />....... _... ......... u__�_ <br />(Description) <br />for a project known as Cleveland Well FieldRefurbishments 11-8.-� ,.... . — <br />(Name of Project) <br />located at <br />and owned by The City of South Bend <br />(OwnerF...�_��,M mm._.. <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <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 is given <br />solely with respect to said amount, andwhich waiver sball be effective only upon receipt of payment thereof by the <br />undersigned; <br />he sum of <br />One (ilun r AL WAIVER) <br />rty-Fi vealThousandTwo Hundredalance due from the F.Qr y Four Doll L �00 <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 uponreceipt of such payment. <br />THEREFORE, the undersigned valves and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a <br />Peen on account of any work performed or material furnished to the undersigned for said project, and withln the scope of this Affidavit <br />and Waiver of Lien. <br />sdwest Inc. y �. <br />Peerless-Mi � <br />(Firm) (Attthorized Representative) <br />STATE OF INDIANA ) <br />) SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for sold County and State, personally appeared <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />1N NE ` WHEREOF, I have hereunto subscribed my name and affixed my oftici1 <br />seai om a day of <br />200 <br />r+tsMrr,��� CATHY S. LANCE NotargI'ttbllcSl na °o <br />My CommissionI x &ti r otna *1~ Notary Public, Stste of Indiana <br />aEA� My commission Expires <br />Residing m _ <br />'µe10a; ° Count Ajj 06, 2023 Notary Public N e <br />11, <br />