PCA - Morris Performing Arts Center Theater Handrails – Proj No. 119-074 - Larson Danielson Construction Co., Inc.

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Final Waiver of Lien State of Indiana, County of LaPorte SS: Timothy F. Larson being duly sworn that he/she is the President (Dante ofOfflcer) ' (Title) of 'Larson —Danielson Const. having contracted with City of South Bend (Contractor) (Owner) tofurnish certain materials and/or labor asfollows. Mo,r.ris Theater Handrails —Install Handrails (Ilescrlptlon) for a project known as 1:19-074 Morris Performing Arts Center Theater Handrails (Name of Project) located at 211 N. Michigan Street, South Bend, IN 46601 and owned by of South bend. Indiana Board of Public Works (Owner) 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 (S _ ❑ receipt of which is hereby acknowledged; or ❑ tite payrnent 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 sball be effective only upon receipt ofpayrnent thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of Five Thousand, Five Hundred Twenty —Eight Dollars 5,528.0' ❑ receipt of which is hereby acknowledged; or the paynrent of which has been promised as the sole consideration forthis Affidavit and Final Waiver of Lien which shall becornc O ofi`eetive only upon receipt of such payment. z THEREFORE, the uuudersignad waives and releases Unto the Owner of said promises, .any and all liens or claims whatsoe on the above described property and improvements thereon an account ofiabor or material both, burnished Cn En r i v or b the undersigned thereto, subject to limitations or conditions expressed heroin, if any; mud further certified that no other party has any claim or right = z ' a z � lien oil acoount of any work performed or material fbmished to the undersigned for said project, and within the scope of this Affida t o z and Walver ofLlen. Larson —Danielson Construction Co., Inc. By (Finn) (A tthoried Representative) STATE OFINDIANA ) Timothy F. Larson, President LaPorte ) SS: ffxg�K COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared _Timothy F. Larson and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WDEREOF, Ihave hereunto subscribed my name and affixed my official seal on the 10th day of Januar 2W 202.0 -. . N"otaty ll'uubll Sl,gnat My Commission Expires: Februar 11 2024 679923 Residingin —LaPorte county, Cath A. Sale Notary P CATHYA. SALE La Porte County My Commission Expires February 11, 2024