Project Completion Affidavit - Gemini at Washington-Colfax Apts Masonry & Stair Repair Project No 118-080B - Pauls Welding

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Final Waiver of Lien State of Indiana, County of SS: w � e, 1. being duly sworn that he/she is the Imam( ( " ' (Name of Officer) �" (Title) ` " of tit City of South Bend having contracted with y (Contractor) (Owner) to furnish certain materials and/or labor as follows;: for a project known as located at and owned by (Name ofProjeot) t I fah- City of South Bend (owner) and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars fi ❑ 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 Lion which is given solely with respect to said amount, and which waiver sball, be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVM that the final balance due Rom the contractor is the sum of ❑ receipt ofwhich is hereby aclmowledged; or ® the payment of which has been promised as tide solo consideration for this Affidavit and Final Waiver of LIen which sball become effective only uponroceipt ofauch payment THBREFORE, file undersigned waives and releases unto the Owner of said promises, any and all liens or claims whatsoever, on the above-descrlbed property and improvements thereon an account of labor or material or botb, tltruished 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 it lien on amount of any work perferrned or material t4mished to the undersigned for said pro eot, and within the scope ofthis Affidavit mid Waiver of Llera r gk (Firm) J) (Authorized Ropresentative) STATE OF INDIANA SS: ST. JOSEPH COUNTY ) 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 Lion. Ji IN WITNE S WHEREOF, I have herounto subscribed my name and mixed my official seal on the � day of Notary Public Signature My Commission R�pfms: r :: a Residhtg in � ��(,��' county, rJj,i` iio Name KEWEPA GINGERICH Notary Public SEAL State of Indiana My Commission Expires February 15, 2025 ............... .