Project Completion Affidavit - J.C. Lauber Site Improvements Proj No 118-083B - Rieth-Riley Construction Co., Inc.

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Final Waiver of Lien State afIndiana, County of St, JOOpil ss: Joshua A. McCormick, being duly sworn that he/she is the Sales Manager (Name of Officer) Title ( ) of Rieth-Riley Construction Co�, InChaving contracted with City of South Bend, IN (Contractor) (Owner) to furnish certain materials and/or labor as follows; Site Improvements (Description) for a project lamwuas JC Lauber Site Improvements 118-083B (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 of the aforementioned subcontractor/supplier: (PARTIAL WAIM) that there is due from the Contractor the sum of Dollars $ ❑ receipt of which is hereby aclmowledged; or ❑ the payment of which has been promised as the sole consideration for this Affdavlt mad Final Waiver of Lien which Is given solely with respect to said amount, and which waiver sball be effective only upon receipt ofpayment thereof by the undersigned; (FINALWAIVER ER that the final'balanca) due from the contractor is the sum of Four Nundred Sixteen Thousand Three Hundred 41, ,36 .38 Sixty S remit of which and 38/100 which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration forthis Affidavit and Final Waiver of Lien which shalt 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, fhrnished b the undersigned then al , subject to limitations or conditions oxpressecl herein, if" any; nand further cortiflecl that no other party has any clrrhn or rl rt to a lien, on account of any work performed ormaterial furnished to the undersigned for sold project, and within, the scope of this Affidavit and Waiver of Lien. fieth-Ry!ey Construction Co.,Inc. �y (Fm) _.. , 0 . r e tativ STATE OF MIANA ) Joshua Mic , �a` e Manager SS: ST, JOSEPH COUNTY ) Ileforeaue, the undersigned, a Notary Public, In and for said County and State,, personally appearedJo s h u a A, MCCOrmick and aclonowledged tiro execution of tho foregoing Affidavit and Waiver of Lien, IN WI LSS WHEREOF, Ihavo hereunto subscribed any name and affixed my o la'l soul a �l t day of OCtober, 20 Notawcy Pu o Signature My Commission Expires: 10/22/22 South Bend Sue Anne Cira Residing in County, StJoseph Notary Public Name SUE MINE CIRA Bell Notary Public • SIM of Indiana St Joaaph County My coom"MISSIM atltlr� t 22, 2022