Project Completion Affidavit - Three Twenty at the Cascade Site Utilities Div B Project No 118-074D - Ritschard Bros

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Final Waiver of Lien State oflndiana, County of St , Joseph SS: Rachelle L. Dolniak being duly sworn that he/she is the President (Name of Officer) (Title) of Ritschard Bros., Inc. having contracted with City of South Bend (Contractor) (Owner) to furnish certain materials and/or labor as follows; Earthwork and Site._Utilities �.� (Description) for a project known as _Thr. ., e Cascade — Site Utilities ('Division B) (Name ofProject) located at �0 E. Colfax ._„venue and owned by City of South Bend (Owner) and does hereby fia Cher state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the aura of Dollars Cl receipt of which is hereby aelaxowledged; or ❑ the payment of which ]was 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 �i Sim Hundred Sevent —four and 35/100 ❑ receipt ofwhich is hereby acknowledged; or ® thepaymeut of which has been promised as the solo consideration forthis Affidavit and Final Waiver of Lien which shall become effective only upon, receipt of such payment. WHEREFORE, the undersigned waives and releases unto the Owner of said promises, 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 lion on account of any work perfomned or material furnished to the winder i ed for said project, and within the scope of this Affidavit and Waiver of Lien Ritschard Bros., Inc. By ) M (Authorized Representative) STATE OF INDIANA ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared ilac 1..1.e L. Dolniak and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed ray name and mixed my o sea n the day of Au ust 200 19 c� "" otaryPublic Signa My Commission Expires; 9 1 2 5 t""."Z. .Robin Fozo Residingin St. e Co�ty, ana Notart' Public Nam e 1 OF MO