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Change Order No 1 & PCA - 2022 Contractor Paving, Round 1 Proj No. 122-008 - Rieth-Riley Construction
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Change Order No 1 & PCA - 2022 Contractor Paving, Round 1 Proj No. 122-008 - Rieth-Riley Construction
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4/14/2025 12:15:32 PM
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5/23/2023 3:00:05 PM
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Board of Public Works
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Projects
Document Date
5/23/2023
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Final Waiver of Lien <br />State of Indiana, County of St. Joseph SS., <br />Ruben Alvardo being duty 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; Contractor Paving <br />(Description) <br />for a project known as 2022 Contractor Paving Round 1 <br />(Name of Project) <br />located at Various Streets in the City of South Bend <br />and owned by CitV of South Bend <br />(owner) <br />and does hereby Dirther state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WA.IWR) that there is due from the Contraotor the sum of <br />Dollars _($ ) <br />Q receipt of which is hereby acknowledged; or <br />[ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver ofLien which is given <br />solely with aspect 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 />one hundred two thousand nine hundred siltysix 5/ 100 $ $102,966.05 <br />receipt of which is hereby acknowledged; ox <br />® the payment of which has been promised as the sale consideration for this Af'fldavit 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 Owner 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 herein, if any; and f€ rther certifled that, no other party has any claim or right to a <br />lien on account of any work performed or material f nished to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver of Lien. <br />Rieth-Riley Construction Co. Iric Ey <br />-_KL-a4i4i�x- <br />(Firm) (Authorized Representative) <br />STATE OF INDIANA ) <br />SS: <br />ST. IOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Ruben Alvardo <br />and acknowledged tho execution of the foregoing Affidavit and Walvor of Lien. Iq IN WITNFSrOF, I have hereunto subscribed my name and afExed my offie!al seal vn the day o€ <br />'202!1 <br />�l. <br />Notary Public atud <br />My Commission Expires: <br />Residing in IN <br />10/03/2030 <br />��,•�`� Y'�;%//' RACMAI L Ifl <br />County, Marshall ,.o�..••..,��,,; Notary Pubiic, s," �; <br />Marshall County *.**Z Commission Number NP0744094 <br />MY Commission <br />October i n Expires <br />2030 <br />ecki <br />Name <br />
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