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Final Waiver of Lien <br />State oflndiana, County of Marshall mm SS: <br />Scott Kirkpatrick being duly sworn that he/she is the President <br />(Name ofOfllner) (Title) <br />of Michiana Contracting, Inc. having contracted with Department of Public Works <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; Accessible Pedestrian Signals <br />(Dasorrlpdoa) <br />for a project Imown as Notre Dame Ave. APS <br />(Name ofprojeco <br />City of South Bend India <br />located et �, aan�..�„�_....��_....�.. ,. <br />and owned by 9LtY of South Bend Indiana <br />and does hex+eby hurther state on the behalf of the aforementioned subconttactor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the awn of <br />Dollars <br />�fS ) <br />❑ rcoelpt 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 is given <br />solely with respect to said amounk and which waiver shall be effective only upon recelpt of payment thereof by the <br />undersigned; <br />(FINAL WAIVHM that the final balance due from the contractor Is the suns of <br />Fifteen Thousand Two Hundred Dollars _ _ g f S 2tlil.l 0 <br />❑ receipt of which is hereby acknowledged; or <br />® thopayment of whicb has been promised as the sole consideration fbrtbis Affidavit and Final Waiver of Lien which shall <br />bcoome effeohve oniyupon receipt of such payment. <br />THBREFORE,, tho undersigned valves and Wesses unto the owner of sold promises, any and all items or claims whatsoever <br />on the obovawdascribed property and improvements thereon on account of labor or ,material orbotb, Arrnished b the undersigned <br />thereto, subject to limitations or conditions expressed havolo, if any; and f mhar certified that no other party has any claim orri t to n <br />lies on account of any wo is performed or material tUrnlshed to the undersigned for saWanzew,this the scope oftbia , efidavit <br />and Waiver ofLien <br />Michiana Contractin Inc. I3y <br />(Firm) e,pr>esentative) <br />STATE OF INDIANA ) <br />SS: <br />929M$XXV�W Marshall ) <br />Before me, the undersigned, a Notary Public, In and for said County and. Slate, ,person lly appeared n Scott f�tr trl k <br />and acknowledged the execution oftho foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHMOF,1 have hereunto subscribed my name and at'lixed sly offi hd a Ion the tha day of <br />January 7SQtDC 2020 / <br />�,... • otary I'tr lie Sign <br />My Commission Expires; �"�� ��)� � ,� <br />Residing in Marshall_ County, Nndlana Notaulr Public Name <br />ANDREA JAE FISHER <br />Notary Public - Seal <br />State of Indiana <br />Marshalt County <br />My Commission Expires Mar 27, 2022 <br />