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Final Waiver of Lien <br />State of Indiana, County of St. Joseph SS. <br />Ruben Alvarado being duly sworn that he/she is the Sales Manager <br />(Name of Officer) (Title) <br />of Rieth- Riley Construction Co., INC having contracted with City of South Bend <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; Install HMA surface pavement, striping and markings and ADA curb ramp. <br />(Description.) <br />for a project known as Contractor Paving Round 2 2022 <br />(Name, of Project) <br />located at Various sreets in South Bend <br />and owned by Cit of South Bend <br />(Owner) <br />and doss hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that thero is due from the Contractor the sum of <br />Dollars $ , <br />❑ receipt of which is hereby acloxowledged; or <br />[l the payment of which has 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 shalt be +eff+ective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />One hundred six thousand five hundred sixty five 59/ 100 ( } $106,565.59 <br />(� receipt of which is hereby acknowledged; ox <br />the payment of which has been promised as the solo consideration for this affidavit and Final Waiver of Lien which shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owmr 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 both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed heroin, if any; and ffirther cerfifipd that no other arty has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for s Id project, d lthin the scope of this Affidavit <br />and Waiver of Lien. <br />By <br />��� (u ori�ed Reprssen <br />STATE OF INDIANA. ) <br />SS: <br />ST, JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared <br />and a"owledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, Ihave hereunto subscribed my name and affixed any a cial seal on the 23 day of <br />March 2023 <br />Notary Public Signature <br />My Commission Expires: 10/03/2030 <br />Rachael Czarnecki <br />u ed <br />C h <br />°coCZ <br />�o- <br />U o <br />2' ` s <br />� �Z,r <br />Utz e o <br />Wi° 0 <br />z <br />`, G <br />Residing in Marshall County, IN <br />iNoutry Public Name <br />