Change Order No 1 & PCA - 2019 Community Crossings Round 2 Proj No. 119-065 - Rieth-Riley Construction Co., Inc.

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Final Waiver of Lien State oflndiana, Coonty of STJOSEPH SS: ERIC ENGLEKING bring duty sworn that he/she is the REGIONAL VP NORTHERN INDIANA (Name of Officer) (Title) of RIETH-RILEY CONSTRUCTION CO., INC. _ having contracted with CITY OF SOUTH BEND (Contractor) (Owner) to furnish certain materials and/or labor, as follows; KII and resurface at least 1.5 inches of HMA surface pavement, provide thermoplastic pa men s repM A ant c=ram Is S, for a project known as 2019 COMMUNITY CROSSINGS ROUND 2,119-065 (Name of Project) located at VARIOUS LOCATIONS - NOTED ABOVE and owned by CITY OF souTII BEND (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier. (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars [I receipt of which is hereby arlaiowledged; or the payinent of which loos been promised as the sole consideration for this Affidavit and Final Waiver OfLion-which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned-, (FINAL WAIVER) that the finai balance due from the contractor is the sum of ONE H-UNDRED THREE THOUSAND, ONE HUNDRED TWENTY-SIX DOLLARS AND 99 CENTS. ($103,12�i.99' El receipt of which is hereby acknowledged; or El the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective only upon receipt of such 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 EM account of labor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party 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 of Lien. RIETH-RILEY CONSTRUCTION CO., INC. (Fhm) thorti6d Representative) STATE OF INDIANA ) SS. ST. JOSEPH COUNTY Before one, the undersigned, a Notary Public, in and for said County and State, personally appeared ERICENGLEKING and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed ray name and affixed my official seal on the 26TH day of AUGUST 200 20 My Commission Expires: 1/5/2028 JrNNIFERMORA 5110"M Moftodaw M y� INDIANA Notary Public N mq,,ol"'V� Residing in County' P&?", "/, Notary Pubha, S� �s o� n6alm, Elkhar � County nnnsskm 4w 0, 2", 0 My cornmi:::: io, IDxpirfI 9 0 21 Januai!)