Change Order No 1 & PCA - Jackson Road Sanitary Sewer Extension Proj No. 119-072 - HRP Construction, Inc.

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Final Waiver of Lien State of Indiana, County of St. Joseph SS: Matthew D. Cain being duly sworn that he/she is the President (Name of Officer) (Title) of HRP CONSTRUCTION INC. having contracted with City of South Bend (Contractor) (owner) to furnish certain materials and/or labor as follows; Installation of a sanitary sewer extension along Jackson Road (Description) for a project known as Jackson Road Sanitary Sewer Extension (Name, of Project) located at Jackson Road, South Bend, IN, St. Joseph County and owned by —City of South Bend (Oster) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the suns of Dollars �$ a ❑ receipt of which is hereby acknowledged; or ❑ the payment of which lies been promised as the sole consideration for this Affidavit and Firtal Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt ofpayntent thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of ix ousan Nine Hundred Sixt y Two Dollars and Ninety Five Cents 6,962.95 ❑ receipt ofwhieh 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. 'IUHREFORE, tho undersigted waives and releases unto the Owner of said promises ,any and all liens or claims whatsoever on the above-dese rlbed property and improventents thereon an account of labor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed hercin, if any, and firrtber oertifled that no outer p has any claim or right ht to it lien, on account of any work performed or material f imished to the undersigned for ,tad project a e scope of this Affidavit and Waiver of Lien. HRP CONSTRUCTION INC. Irtri _.. JJ (Firm) _. ...W (Authoti d.. sentative) STATE OF INDIANA ) Matthew D. Cain President SS: ST. JOSEPH COUNTY ) ]Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Matthew D. Cain and acknowledged the execution of the foregoing Affidavit and Waiver of Lion. IN WITNESS WHEREOF, Ihave hereunto subscribed my name and affixed my official seal on the 17th day of December 2019 4N#ub le Slgn My Commission Expires; 03/06/24 Residing in St. Joseph County, _ Indiana L. Vanheste "t" lit .i 0- A Lr i•i E S T Notaty f iAblir„, SWO rat htdiane SF 0" � 6t. Joseph County -Alt .M COMMissian Number 681273 ," My Corm mission Expires March 06, 2024