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Change Order No 1 & PCA - Pinhook WTP Guaranteed Savings Contract Proj No. 119-003 - Bowen
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Change Order No 1 & PCA - Pinhook WTP Guaranteed Savings Contract Proj No. 119-003 - Bowen
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9/13/2023 9:23:52 AM
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Board of Public Works
Document Type
Projects
Document Date
9/12/2023
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1
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9/13/2023 9:23 AM
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BOWEN <br />Engineering Corporation <br />WAIVER OF LIEN <br /> {X} Final { } Partial {X} Payment to Follow <br />State of Indiana, County of ___Newton______________________________________________, SS: <br /> <br />_____Patrick Stanford_______________________________ being duly sworn states that he/she is the __Project Manager___________________ <br /> (Name of Officer) (Title) <br /> of__ Bowen Engineering Corporation__ having contracted with _City of South Bend, IN ___ <br /> (Contractor) (Owner) <br /> <br />to furnish certain materials and/or labor as follows: ___Supervision, Labor, Equipment and Material________________________________ <br />(Description) <br />for a project known as __Pinhook WTP Improvements <br />located at _2800 Riverside Drive, South Bend, IN 46628 <br />and owned by City of South Bend, IN ___ <br /> (Owner) <br />and does hereby further state on the behalf of the aforementioned Contractor: <br />(PARTIAL WAIVER) that there is due from the Owner the sum of <br /> ___________________________________________________________________________________________________________($ ) <br />{ } receipt of which is hereby acknowledged; or <br />{ } the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of <br /> Lien which is given solely with respect to said amount, and which waiver shall be effective only upon <br /> receipt of payment thereof by the undersigned. <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br /> TWENTY FIVE THOUSAND FOUR HUNDRED SEVENTY EIGHT DOLLARS ($25,478.00) <br /> <br />{ } receipt of which is hereby acknowledged; or <br />{X} the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of <br /> Lien which shall become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the <br />above-described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right <br />to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this <br />affidavit and waiver. <br />___Bowen Engineering Corporation___ By ____ _______________________________________ <br /> (Firm) (Patrick Stanford, Project Manager) <br />WITNESS MY HAND AND NOTORIAL SEAL, this ____5TH ____________ day of __April 20_23_______. <br /> <br /> __________________________________________________________ <br /> (Notary Public) <br />My Commission Expires_____June 5, 2024_____ Printed _______Margaret Burroughs____________________________________ <br />Residing in ____Newton________________________ County <br /> <br />10769 Broadway, #325, Crown Point, IN 46307 <br />219-661-9770 Fax: 219-661-9766
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