Project Completion Affidavit - Small Drainage Design and Repair Div C Project No 118-063 - Walsh & Kelly

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Final Waiver of Lien Slate of Indiana, County of ...._._..�,.......em Stw __Os6 Jii .... SS: Dustin Hilaryu yW w .... M y mm being duly sworn that he/she is the South Bend AreaVicePresident (Name of Officer) (Title) Walsh & Kell Inc. m..m ... having contracted with._.... __.. _en of CiY of St out...h Bend _ ...�w�.......�.� _M (Contractor) (Owner) to furnish certain materials and/or labor as follows A �i alt wPa ing, COnCre 'e,wSewer and Landsc e t. (I:IcscrJirtion) for a projeot known as SmallYDraina Design &, Re aqr Div CrµProject# 118-063 (Name of Project) a ..._ ... located at Creekwater, Street, South Bend, IN 46628 and owned by City of South Bend, Indiana++tlttit,,, and doe hereby r state nbehalf s h y furthc tat o the ofthe aforementioned subcontractor/supplier. from the Contractor the sum of (PARTIAL WAIVER that Were is due .,, m .. , . w.....n. Dollars _ ...m.., ❑ 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 g%vm 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 3,610 0 ❑ 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-doserlbed property and improvements thereon an account of labor• or material o. , ftunished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and Iivther ccrtifl at other° la s any claim or right to a lien on account of any work performed or materiel furnished to the undersigned for dd p Oct, .and the scope of this Affidavit and Waiver of Lien. _ Walsh & Kelly, Inc _...... (Authorized g�nsscn(aii�rre) STATE.. �..__.._._ OFINDIANA ) D tin Hilary, South Bend Area Vice President SS: ST. JOSEPH COUNTY Before me, the undersigned, a Notary Public, in and rr said County and State, personally appeared Dustin Hilary and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscrJbed my na� and affixedmy ofticisi ion Rl r� ,th day of UqUSt 200_ lary public SJgnat�u^e My commissionr.xpires: m June 7, 2023 Ammer Elizabeth Turin_ _.._ Realdingin Marshall County, _ Indiana W Notary Public Name AMY ELIZABETH TURPIN `rr;d Nctary Pub 1c, State of Indiana Marshall Cour:y Commission Expires Jung 7, 2023