Project Completion Affidavit - East Longfellow Ave. & North Riverside Dr. Traffic Calming Proj No 118-113 - Walsh & Kelly, Inc.

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Final Waiver of Lien State of Indiana, County of St. Joser)h SS: Dustin Hilary being duly sworn that he/she is the South Bend Area Vice President mm (Name of Officer) (Title) of .--Walsh & Kelly, Inc. having contracted with City of South Bend (Contractor) to furnish certain materials and/or labor as follows; ----.Speed Bumps . . .. .. . ........ (Description) for a project known as E._Lonqtqplc W_Ave N. Riverside Dr. Traffic Calmi , Prqjept# 118-113 . . . . . . . ... . ........... (Name of Projeot) located at E. Longfellow Avenue & N. Riverside Drive, South Bend, IN 46628 .. ............. and owned by City of South Bend, Indiana (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 acknowledged; or E] 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 34,799.44 El receipt of which is hereby acknowledged; or 91 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 sold premises, any and all liens or claims whatsoever on the above-deserlbed property and imjn ovv: Tientst vvnllrj�j ecoutit of labor or material or 1) fUrnished b the undersigned thereto, subject to limitations or conditions exp# Am] further cartTl�eVdA ho , per paly has any claim or right to a lien on account of any work performed or rn 4;*QQ, ve'rilp I proj , an IhIn the scope of this Affidavit r� qS i and Waiver ofLien. zt, ?0F1A'r,,_- Walsh& Kelly, Inc .= 14y= ... .... (Hral) ithon zed' R eprosentat No) STATE OF MIANA tin Hilary, South Bend Area Vice President SS, ST. JOSEPH COUNTY Dustin Hilary Before me, the undersigned, a Notary Pt� hid County and State, personally appeared and acknowledged the execution of the foregoing Affidevil. d Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my naand affixed my offyrlicl' It scull on the 31 st day of M October 200 i� o�y P, ub I I cS1 . gnaMm My Commission Expire,: June 7, 2023 Am Elizabeth Tur in Residing in Marshall c Indiana N rwy�,,,b County, "4_404�� PIN