PCA - Drewry’s Brewery Fence Replacement Proj No. 119-031B - Ritschard Bros., Inc.

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State of Indiana, County of St. Joseph SS: Rachelle L. Dolniak being duly sworn that he/she is the President (Name of Officer) (Title) of Ritschard Bros., Inc. having contracted with City of South Bend (Contractor) (Owner) to fiimish certain materials and/or labor as follows; Fence removal and replacement, incl. asbestos inspector (Description) for a project known as 119-031B Drewry's Brewery Fence Replacement (Name of Project) located at 1408 Elwood Avenue, South Bend, Indiana and owned by City of South Bend (Owner) and does hereby Author state on the behalf of the aforementioned subcontractor/supplier; (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars ❑ receipt of which is hereby acknowledged; or ❑ the payment of which lies been promised as the sole consideration for this Affidavit and Final Waiver ofLien 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 WAIVE that the final balance due from the contractor Is the sum of One Hundred Eighteen Thousand Two Hundred Sixty Dollars ($118,260.04 ❑ receipt of whiah is hereby acknowledged; or ® 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-deserlbed 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 certified that no other party has any claim or right to a lien on account of any work perfonned or material famished to the understhned for said project, and within the scope of this Affidavit and Waiver of Lien. E y� Ritschard Bros., Inc. By �� (Firm) (Authorized Representative) STATE OF INDUINA ) ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WDEREOF, I lave hereunto subscribed my name and affixed my official seat on the 3 r d day of February 202 3 GNp RD g,c� '/,,�� No Public Signature O , My CommissionExpiros; 2 2 2 ' AlCD `sue Michaela Ritschard Residingin St. Joseph County; Indiana__ = Notary Public Name - AOBUG 111� OF It0\0\`1 �'��rrriit00 Rachelle L. Dolniak