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04 <br />r-, <br />State oflnscums, County of Saint Joseph ss: <br />Jen Timmons being duly Mum that hNahe is the Project Accountant <br />(Name ofoffi-) (py1111) <br />of Milestone Contractors North, Inc.hsyrg emo-actadwRh CiTy. of South Bend Dept. of Public Works <br />(Contractor) (Owner) <br />to llvnish cermin meteride md/or labor ea Rgowa: Concrete <br />_-. _. Neaalptlon) <br />for a pmjcctknown as Curb and Sidewalk Round I (DivI + 2) <br />(Name ofPro)eat) <br />located at Various Locations <br />and owned by City of South Bend <br />and does hereby father s sm on the behalf othhe aforementioned sutamuractoussuppller: <br />(PARTIAL WAIVER) Watthm, is due from the Contractor the sum of <br />Dollars <br />❑ racelptofwhich ishembyeolmowledged;or <br />❑ the paymentofw1d le has been promhedas the aolaoomidoredon for this Affidavit and Phial WalverofLimurbLch is given <br />sololy with respeat to add amount, and which waives shall he effective only upon rocelpt of payment thereof by the <br />undersigned; <br />((PENAL WAIVgR�tLttir am`bel co duehom the cmrtr of 30.927.32 <br />thtr[y thousand nine �iun ldregtwenty-seven and SL/ l UU (S <br />❑ reenlist afwfiiah is hereby acdmowledged;or <br />® the payment of which has been promised as the tole consideration for this Affidavit and Final Waists of Lin which shell <br />heeoms affnative only nponreceipt of much payment. <br />THEREFORE, the undersigned waives and leases unto the Owner afsaid promises, any and all liens or claims whatsoever <br />on the above-deanlbedpropevty and improvements therms an account of labor or material or both, famished b the undersigned <br />thereto, subject to limitation orcanditiona expressed hereto, if any; and fathercarefled_ that no other party has my claim or right m a <br />Jim on mcouN ofany "]it performed or materiel famished to the undarsignod W(0014 Jostled, and within the scope of this Affidavit <br />and Waiver of Lim. <br />Milestone Contractors North, Inc g' f/YYI/'!I V71, <br />(Ashorimd Raprsannslive) <br />STATEOFINDIANA mc) ) <br />as: <br />ST. JOSEPH COUNTY <br />Eaten me, the mderelgned, allota , Public, In and for said County and Share, personally appeared Saint Joseph <br />and aoWnwImped the execuHm of the foregoing Affidavit and Waiver of Lim. <br />IN WITNESS WHEREOF,Ihaw hseunto Subscribed my acme and affixed my offieiNSe pre 26th dayof <br />June 202; <br />bllo Slgnemre 2L <br />My ConmAebn Expires: June 5, 2030 <br />LaPorte Alisha Krueger <br />Raddingln Costly, Indiana NosryPubga Nam <br />..Mf,.•^•., <br />f¢:' ; <br />QISHANRUESE'+. <br />aQ'Commesbn 77 <br />•: $fAL • <br />Jura h, M30 <br />�jF��: <br />CaIIYIYSsion Nun!;+r P'�: ., <br />