Project Completion Affidavit - Unity Gardens Learning Center Site Improvement Project No 117-050R - Ritschard Bros

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Final Waiver of Lien State of Indiana, 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 aproject:know as l txit (Iar darts Learnin Center Improvements (Name of Project) located at —3.7-QL— raat B1yd Bend, IN and owned by ity of South Bend (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars _($ ) ❑ receipt of which is hereby aclatowledged; 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; (FINAL WAIVER) that the final balance due from the contractor is the sum of Tive Thousand Four Hundred Fift -2i ht and 34/100 5,45t3.34 ❑ receipt ofwhich 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 Ownor ofsaid premises, any and all liens or claims whatsoever on the above -described ,property and improvements thereon an account of labor or material or both, flrrnished b the undersigned thereto, subject to limitations or couditions oapressed herein, if any; and further certified that no other party has awry claim or right to a lien on account of any work performed or material furnished to the underLed r said project„ and within the scope of this Affidavit and Waiver ofLien. Ritschard Bros., Inc. BY �) (Atttitorized �eprosentative) STATE OF MDIANA ) SS: ST. JOS131"H COi:1NTY Ilefore me, the undersigned, a Notary Public, in and for sold County and State, personally appeared Rae lle L. Dolniak and aclatowledged the execution of the foregoing Affidavit and Waiver of"Lien. IN WITNESS WHEREOF, I have hereunto subscribed, my name andaffixed my offacl al .i the 2 th day of —August _ tltt 19 X N e01 � i� , �✓', N Public Signature My Commission Expires: 918 25 " 4 Robin Fozo Residing in S.t_._h county, "Marne OF ' rr110111000