Change Order No 1 & PCA - Gemini Site Improvements Proj No. 119-043 - Rieth-Riley Construction Co., Inc.

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State of Indiana, Cotmty of Final Waiver of Lien St Joseph Joshua A. McCormick -being duly swom that he/she is the (Name of Officer) ,fRieth-Riley Construction Co., Inchavirig contracted with (Contractor) to furnish certaiti materials and/or labor as follows-, 119-043 (Tide) City of South Bend (Owner) (Description) for a project known as Gemini Site Improvements (Name of Project) located at 617 Washington St Alld owned by City of South Bend and does, hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WArVER) that there is due from the Contractor the sum of DoVars F1 receipt of which is hereby a0zowledged; or the payment of which has been promised as the sole consideration for this Affidavit and Filial Waiver of Lienwhich is given solely with respect to said amount, and which waiver shall be effective 0111Y upon receipt of payment thereof by the undersigned; (FINALWAIVER) that the finial b I fm due ftom, 0 C N actor is the Urn of �L '), I i If I e) I It, rc s7 two 2 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 ofsach 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, furnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further vortified that no other pwty has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of1lon. Rieth-Riley Constructidn Co., Inc. 13Y (Firm) STATE OF IMIANA LAUthorize SS, ST. JOSEPH COUNTY Joshua A. McCormick Before me the undersigned, a Notary Public, in and for said County and State, personally appealed and acluiowledged the execution of the foregoing Affidavit and Waiver of Liam —A gilWITNESS WBEREOP, I have hereunto subscribed my200TO no pandaffixedmyofficials7loliffic 1 3th day of "N C _,ir", Aillkq .7, My Commission Expires-, 1/5/2028 Jenn`�ier Mora Residing in Elkhart county, I N Notary y J E N E R V',A 0 R)11� j 14clar" ySlote of ki,(Jhln SE A, Nkhv � C4>unty A' 6 Con,imission Number NF10724328 My C�wmn�ss�on ExpheB JaPo(X5, 20�28 emu