Change Order No 4 & PCA - Miami Street Basin Drainage Improvements Project No 116-082C - HRP Construction

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Final Waiver of Lien State of Indiana, County of St. Joseph Nancy K n a p i k_ being duty sworn that he/she is the (Name of Officer) of HRP Construction Idc. (Contractor) SS: Vice President (Title) having contracted with City of South Bend, Indiana (Owner) to famish certain materials and/or labor as follows: per contract for'_ the Miami Street Basin (Description) for aprojeetknown as Miami Street Basin Improvement project 116-082C (Name of Project) located at Miami Street, South Bend, Indiana and owned by CitY of Soa.ith Bernd Indiana eartment (Owner) and does hereby fiuther state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the suns of .. Dollars ($ ❑ receipt of which is hereby acknowledged; or ❑ the payment of which lies 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 X@ '• ',u--teas ::*�,..°...:�,..`a.yr�,�, �.. T"r, Ha,1. �.^�.,,C,",*,.'"! rv.J ,..(�_.. ❑ 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 -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 accouttf of any worts performed or material ftrnished to the undersigned for said project, and within the scope of this Affidavit and Waiver HRP CONSTRUCTION INC. B n (Fim) (Ruth rized'Representative)' N a n c y K n a p i k STATE OF INDIANA ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared ; a n y K c1 a c: and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF I have hereunto subscribed m name and affixed m o 'c'ial seal on the 2 4 t h day of Y Y Se tember ZOO 2019 N Public Signature ^ n r y a t e My Commission Expires: 7 nR az,„ Residing in h _- County, , ..! n d i a n a i N"��"v'�.,� C=L.VVANHEyECind�Va �r•.r� ^; h�afe o1 Ymwaii�unallotary Public N "SgA�L '� - County Cmber 681273A,wyv,� p' 'ion ExpiresfplI14rw`0 6, 202�i