Laserfiche WebLink
Final Waiver of Lien <br />State of Indiana, County of Berrien SS: <br />Justin Butler being duly sworn that he/she is the Vice President <br />(Name of Officer) (Title) <br />of Selge Construction Co., Inc. having contracted with City of South Bend <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; Install Qwick Ku rb <br />(Description) <br />for a project known as Grandview Ave and RR Qwick Kurb Installation <br />(Name of Project) <br />located at Grandview Ave at the NICTD and Norfolk Southern crossings ' <br />and owned by City of South Bend <br />(Owner) <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />❑ receipt of which is hereby aclmowledged; or <br />❑ 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 shall be effective 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 />Seventeen Thousal2d Seven Hundred Eighty Five Dollars and Zero Cents L$17,785.00) _ <br />❑ receipt ofwhich is hereby acknowledged; or <br />i <br />❑ the payment of which has been promised as the sole consideration forthis Affidavit and Final Waiver of Lieu which shall <br />become effective only upon receipt of such payment. !!! <br />TBEREFORE, 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 au account of labor or material or both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and farther certified that no other party has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver of Lien. , <br />Selge Construction Co., Inc. B c <br />y r '-'' i President <br />Michigan (Fim) (AuthmizedRepresentative) <br />STATE OF� 1 <br />) <br />Berrien ) SS: ; <br />31x 19EM COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Justin Butler <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, Ihave hereunto subscribed my name and affixed my o alai seal on the 7th day of <br />- - April BIEI%,20 <br />yL���� r i <br />C.O. rb;-, � ".��1 otsiy Public Signature <br />My Commission Expires: 10/27/2027 <br />' q` <br />' --1 =Allison Swinehart ! <br />Residingin Michigan County, Berrien; �'�, y��r'°8r' �FllotarypublicName <br />