PCA - Water Works North Pumping Station Well Replacement Proj No. 117-031R - Peerless Midwest, Inc.

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Final Waiver of Lien State of .kl:r , County of CAS-5 SS: James R. Williams being duly sworn that he/she is the G r 1 Ma nA (Name of Officer)(Tit a) of Peerless -Midwest, Inc. having contracted with CIULJQLWorks (Contractor) (Owner) to furnish certain materials and/or labor as follows: Water Works North Pumping Station Well Replacement (Description) for a project known as �Por "ect No 117-081R Water Works lJorth m � (Name of Project) Well No. 1 City's North Station Treatment Plant located at and owned by South Bend Board of Public Works (Owner) and does hereby Anther 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 aclutowledged; 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; (F�1VAL WAIVER) that the final balance due tom, the contractor is the sum of Fifty -Six Thousand Four Hundred Seventy-Tw2._.78 cents 556_472.7D ❑ receipt of which is hereby a6mowledged; or the payment of which has been promised as the sole 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 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, famished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and farther cartifled that no other party has any claim or right to a lien on account of any work performed or material famished to the undersigned for sold projEet, and within the scope of this Affidavit and Waiver of Lien. Peerless -Midwest, Inc. By �"""""� (Firm)_qZ(Authorized Representative) STATE OF M1. t`. � SS: COUNTY Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared James R . Williams and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. a n ua r w.i swat on the 7- r day of IN ESS 1tEOF, ave ereunto subscribe m name and affixed my oflicg W Notary Public - Michigan Noly Public Signature Cass County My Commission Expires Jul 5 Ct My Commission Expires:--Arttq In Ulu UU11Y of P Robin L . Kea 1 y Residing t3'� in Cass Coun Notary Public Name .�.�..