Project Completion Affidavit - Code Enforcement Door Installation - Brown and Brown

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Final -Waiver of Lien State oflndiana, County of Elkhart SS: Eric Brown being duly sworn that he/she is the President (Nam ofOfficer) (Title) oprown & Brown General Contractor I9c. City �i'�v g contracted withY of South Bend, IN (Contractor) (Owner) to furnishcertair: materials and/or labor as follows: additional door work (Description) for a project known as Code Enforcement (Name of Project} located at South Bend, IN and owned by City of South Bend, IN (Owner) and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: (PARTIAL WAVER) that there is due from the Contractor the suns of Dollars ❑ receipt of which is hereby acitnowledged; or ❑ the payment of which has 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; TFINAL WAIVE, that the final baler a du from t con f ree thousand one h�undr'eand -el an theT 'rs ❑ 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 reocipt of such paymenrt THEREFORE, the undersigned waives and releases unto the Owner ofsaid premises, any and all liens or claims whatsoever on the above -described property and improvemnent$ thereon an account oflabor or rnataial or both, ftnrnished b the undersigned thereto, subject to limitations or couditious expressed herein, if any-, and Rather certified drat no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said lr ' ct and wlt the scope ofthis Affidavit and Waiver of Lien. '� Brown & Brown General'Contractors, Inc. (Firm) uthori d Representative) STATE OF INDIANA ) SS: ST. JOSEPH COUNTY Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared E ric B rown and aclmowledged the execution of the foregoing Affidavit and Waiver ofLien. IN WITNESS WHEREOF", I have hereunto subscribed my � nd affixed my official seat on the t 5th day of August 200 0041 �. Notes Public Signature My Commission I;•°sxpires: 4/3/2025 Todd A. Marek Resldingin Marshall county, Indiana -- odd A Mwek Notary Public SEAL Marshall County, state of Indiana Da.+bY Corn fission xpires April' ~3, 202'5 Commission Number: 698752