Project Completion Affidavit - Gemini at Washington-Colfax Roof Improvements Project No 118-080A - Dudeck Roofing

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Final Waiver of Lien State of Indiana, County of St. Joseph SS: Catherine Dudeck being duly sworn that he/she is the President (Name of Officer) (Title) of Dudeck Roofing and Sheet Metal, Inc. having contracted with City of South Bend, Indiana (Contractor) (Owner) to furnish certain materials and/or labor as follows; Roofing and Associated Sheet Metal (Description) for a project known as Gemini at Washington -Colfax Apartments (Name of Project) located at 617 W. Washington Street / South Bend, IN and owned by City of South Bend, Indiana (Owner) and does hereby further state on the behalf of the aforementioned subcontrsctor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars $ ❑ receipt of which is hereby aclmowlodged; or ❑ the payment of which lots 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 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 $31,815.05 ❑ receipt of which is hereby acimowledged; or ® the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective onlyuponroceipt 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 -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 lien on account of any work performed or material furnished to the undersigned for said project, and wi'thlr) the scope ofthis Affidavit and Waiver of Lien. Dudeck Roofing and Sheet Metal; Inc. BY (Firm) (Authorial Representative) STATE OF INDIANA ) ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Catherine Dudeck and aftowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS Wl-ZREOF, Ihave hereunto subscribed my name and affixed my official seal on rite rd 4'y of August gyp( 2019 - Notary Pa 1 c Igaa My Commission Expires: 8 St. Joseph ty No P"?1.' Residing to p Coun , Indiananie