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State of Indiana, County of <br />Final Waiver of Lien <br />St. Joseph <br />SS: <br />Dustin Hilary VP of South Bend Area <br />being duly aworn that he/she is the <br />(Name of Officer) (Title) <br />Of Walsh & Kelly having contracted with City of South Bend <br />(Contractor) (Owner) <br />to Awfish certain materials and/or labor as follows; Michigan Street Pavement Replacement <br />......... . ............ <br />(Desoription) <br />for a project known as Michigan Street Improvements <br />(Name of Project) <br />located at South Bend, Indiana <br />and owned by City of South Bend, Indiana <br />(owner) <br />and does hereby further state on the behalf ofthe aforementioned suboontraotor/supplier. <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />❑ receipt of which is hereby acknowledged; or <br />❑ the payment of which boo been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given <br />solely with respect to said amount and which waiver sball be effective only upon receipt ofpsyment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />Ninety-four thousand, eight hundred fifty-eight dollars and 15/100 94L858 15 <br />0 receipt 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 Lim which shall <br />become effective only upon receipt of such payment <br />TMEFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or botb. flimished b the undersigned <br />thereto, subject to limitations or conditionsphk y; and farther certified tha;, hb'o� party has any claim or right to a <br />o undersigned for said pirject,,eLd wltbig0d-e scope of this Affidavit <br />lien on account of any work performed T�W-ftflsl, <br />........... <br />• <br />and Waiver ofLIen. %:�,- <br />,% c� .. !--, <br />Walsh & Kelly' - Z � C)�?%- <br />: ORATe <br />E? <br />(Firm) ,Ozad <br />? �prized Representative) <br />STATE OF INDUNA sFAL.-- "Dustin Hilary, VP of South Bend Area <br />ST. JOSEPH COUNTY 5 ......... <br />Before me, the undersigned, a Nota&.1yblift) County and Stale, personally appeared <br />ft Dustin <br />kAflary_ <br />and acknowledged the execution of the foregoingfAfiftimidmaiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official so, on the 4th day of <br />Ma 2OCK20 <br />No- ub "Ic Signature <br />My Commission Expires: <br />6/5/22 <br />Residing in ____S�Jose h ­ _. County, Indiaga <br />Alisha <br />ALISHA KRUEGE�,,, <br />Wnry PubliC, State of I J: W,# <br />=`SEAI St.JosephCounty J, <br />z <br />My COMMS$iorl E'xpl <br />June 05, 2 0'22 <br />