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Final Waiver of Lien <br />State of Indiana, County of Marshall SS: <br />Scott Kirkpatrick being duly sworn that he/she is the President <br />(Name of bifi—c i <br />(N faer <br />of �� <br />(Title} <br />Michiana Contract' Inc. having contracted with DePa'�t of Public Works <br />(Contractor) <br />(Owner) <br />to furnish certain materials and/or labor as follows: Flashing Beacon Relocation <br />(Description) <br />for a project known as School Zone Beacon Relocations <br />(Name ofProjeot) <br />located at City of South Bend Indiana <br />and owned by City of South Bend Indiana <br />(Owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the suns of <br />Dollars <br />❑ receipt of which is hereby aclaiowledged; or <br />❑ the payment'of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lienwhich is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />Nine Thousand _ rsJl-. , <br />800,00 <br />❑ receipt of which is hereby acknowledged; or <br />the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or both, flamished b the undersigned <br />thereto,, subject to limitations or conditions expressed heroin,, if any; and further certified that no other party has any claim or right to a <br />lien on account of any work performed or material famished to the undersigned for sai4(Aut <br />'d Ithin the scope of this Affidavit <br />and Waiver of Lien. <br />Mich�iara t ntract ' <br />.Inc. a� ....�.�...m..,. IIy <br />(Firm) x cprescntative) <br />STATE OF INDIANA ) <br />Marshall ) SS: <br />�, , q . M COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Scott Kirkpatrick <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lion. <br />IN WITNESS WHEREOF, I have hereunto subscribed mv name and affixed my off/ also on the day of <br />My Commission Expires: <br />Residing in <br />ANDREA JAE FISHER <br />Notary Public - Seal JZLoPubliS1 1110 <br />State of Indiana <br />y Commis 27, 2022 _ <br />oM >� Commission Expires Mar Notary Public Name <br />