PCA - 2022 Traffic Calming Rubberform Installation Proj. NO. 122-014A - HRP Construction Inc.

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Final Waiver of Lien State of Indiana, County of St. Joseph SS: Nancy Knapik being duly sworn that he/she is the Vice President (Name of Officer) (Title) of HRP Construction Inc. having contracted with City of South Bend (Contractor) (Owner) to furnish certain materials and/or labor as follows: (Description) for a project known as 2022 Traffic Calming Rubberform Installation, Project No. 122-014A (Name of Project) located at Various Locations through out the City of South Bend and owned by City of South 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 ($ ) ❑ receipt of which is hereby acknowledged; or ❑ the payment of which lies been promised as the sole consideration for this Affidavit and Final Waiver of Lien 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 final balance due ffom the contractor is the sum of Seven Thousand Fifty Six Dollars and No Cents ❑ receipt of which 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 -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 certified that no other party has any claim or right to a lien on account of any work perforined or material furnished to the undersigned for sold project, and within the scope of this Affidavit and Waiver of Lien. HRP Construction Inc. By —_ (Fim) :7i( 1 Representative) STATE OF INDIANA ) Nancy Knapik, Vice President SS: ST, JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Nancy Knapik and acknowledged the execution of the foregoing Affidavit and Waiver of Lion. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seat on the 6th day of April 2423 Nobty Public Signature My Commission Expires: March 6, 2024 THIA ...... ��% Notary IPutili Residing in St. Joseph County, Indiana =$, :n St. dosNots@pii'ablicNs Commission Number 681273 my March Commission Expires