Project Completion Affidavit - The Garage Site Improvements Proj No 118-083C - R & R Excavating Inc.

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Final Waiver of Lien State of Indiana, County of St. Joseph _ SS: William Loudin being duly sworn that helshe is the President (Name of Officer) (Title) of R&R Excavating, Inc, havingcontracted with City of South Bend, Indiana (Contractor) (Owner) to famish certain materials andlor labor as follows: waterline repair & site restoration (Description) for a project known as The Garage Site Improvements; Project No. 118-083C ^»lance ofProjeot) located at 503 E. Colfax Avenue, South Bend, Indiana and owned by Citv 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 .e..w 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 eMetive only upon receipt of payment fliereof by the undersigned; ( ) sutra of � Dollars Two (FINAL alt�irreni-luaiadred Seventy—two contractor 1 ❑ 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 onlyupon 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 account of any work perfonned or material famished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. R&R Excavating, Inc. ByZZ Y (Authorized Representative) STATE OFINDIANA ) William Loudin, President SS: ST. JOSEPH COUNTY } Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared William Loudin IN acknowledged the foregoing ve heret Affidavit subscribed y na ne and affixed m official seal on the g g 22nd day of an October 2m 201 Notary Public Si att tr My Commission Expires: 9 / 28 / 2024: Rebecca S. Blackston Residingin St. Joseph County, Indiana Nol%mP .bi _ nra REBECCA SBLACKSTON y %O �y e;Notary Public, State of Indiana E�SEASt, Joseph County My Commission Expires rpmryr µ` September 28,2024 Ain