PCA - Lafayette Building Exterior Renovation, Division A – Proj No. 117-100R - Precision Wall Systems, Inc.

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Final Waiver of Lien State of Indiana, County of St. Joseph SS: James Mroz being duly sworn that he/she. is the President (Name of Officer) (Title) of Precision Wall Systems, Inc. having contracted with City of South Bend (Contractor) (Owner) to furnish certain materials andlor labor as follows: Glass and Glazing (Descriptlou) for a project known as 117-10OR Lafayette Building Exterior Renovation (Name of Project) located at 115 S. Lafayette Blvd., South Bend, IN and owned by City of South Bend (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 ❑ the payment of which has 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 eleven thousand ei ht hundred ninety and 60/100 $11690, 60 ❑ receipt of which is hereby acknowledged; or ® the payment of which has been promised as the solo 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 ainto the Owner ofsaid 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 performed or material furnished to the undersigned for saidproject, and ttrl a scope oifthis Affidavit and Waiver of Lion. µ Precision Wall Systems, Inc. By (Firm) (Au on ed Rep re e) STATE OF DMIANA ) SS: ST. JOSEPH COUNTY ) efore me, the undersigned, a "Notary Public, In and for said County and Slate, personally appeared James M roz and acl:ttowledged the execution oftho foregoing Affidavit and Waiver of Lien. I December N W10t1 1 affixed m official al on the 16th day of N T1F1RS WHEREOF, I leave hcrennto saabs+cribed name and My Commission Expires: 8/1 7/2026 �� Pu"�i1,Sigttatsara Primary Employment Residing in St. Joseph County Indiana Notary Public ° A s Primarily Employed in Indiana Commission Number NP0715351 My Commission Expires 08/17/2026