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State of <br />County of <br />WAIVER OF LIEN <br />. I <br />Indiana SS: <br />LaPorte SS: <br />Final <br />Partial X <br />Payment to Follow X <br />Whereas, the undersigned, LARSON-DANIELSON CONSTRUCTION CO., INC.,having been employed by <br />SOUTH BEND, CITY OF to furnish certain Material and Labor, to wit: <br />Community building, support building, and numerous site improvements for a 12 acre park including but not limited to ice trail, playground with <br />rubber surface and interactive water feature Per Plans, Specs and Contract for the building owned by: <br />SOUTH BEND, CITY OF and located at: <br />219 SOUTH SAINT LOUIS BLVD C/O LARSON-DANIELSON CONST SOUTH BEND, IN 4661 <br />and does hereby further state on behalf of the aforementioned Contractor, <br />PARTIAL WAIVER I <br />that there is due the sum of <br />seven hundred fifty-six thousand one hundred fifty-three and 15 / 10C <br />receipt of which is hereby acknowledged: or $756J53.15 <br />X the payment of which has been promised as the sole <br />consideration of this Partial Waiver of Lien which is given solely <br />with respect to said amount, and which waiver shall be effective <br />only upon receipt of such payment <br />FINAL WAIVER I <br />that the final balance due is the sum of <br />receipt of which is hereby acknowledged: or <br />the payment of which has been promised as the sole <br />consideration of this Final Waiver of Lien which shall become <br />effective only upon the receipt of such payment <br />THEREFORE, the undersigned waives and releases existing liens, rights and claims to the extent of payment <br />only for labor, material, equipment or any combination thereof, furnished to the OWNER of said premises for <br />improvements thereon. r <br />Company: CARBON ANI,71 NST. CO. INC <br />By: - <br />Patti L. O'Brien, C.F.O. <br />WITNESS MY HAND AND NOTARIAL SEAL, THIS DA F March 2020 <br />My Commission Expires: <br />Residing in: LaPorte County <br />Notary No. <br />654434 <br />Customer: <br />CITYS1300 <br />Job: <br />56-445 <br />Invoice: <br />56445-00017R <br />Notary:°/ <br />Printed Name:._/—nn-iferA. Medleo <br />JENNIFER AI LEY <br />t,lotory Publie, 814te of Indiana <br />-�-SEAL10Zi <br />dsrfortoCounty <br />r'•, <br />Commission N 664434 <br />My Commission Expires <br />August 01, 2022 <br />