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Change Order No 1 - 2022 CCMG Road Rehabilitation Proj No 122-024R - Milestone Contractors North Inc (1)
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Change Order No 1 - 2022 CCMG Road Rehabilitation Proj No 122-024R - Milestone Contractors North Inc (1)
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4/14/2025 12:09:27 PM
Creation date
11/28/2023 2:13:57 PM
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Board of Public Works
Document Type
Projects
Document Date
11/28/2023
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P,i,l Milestone <br />AFFIDAVIT AND WAIVER OF LIEN <br />STATE OF INDIANA <br />SS: <br />COUNTY OF ST. JOSEPH <br />FINAL <br />Payment to Follow <br />John Conway being duly sworn states that he is the Project Accountant of Milestone Contractors North, Inc. having <br />contracted with CITY OF SOUTH BEND, INDIANA to furnish certain materials and/or labor as follows: ROADWAY <br />REHABILITATION for a project known as COSB 2022 CCMG ROAD REHAB (MCLP Job# 229718) located at SOUTH <br />BEND, IN and owned by CITY OF SOUTH BEND and does further state: <br />FINAL WAIVER: that the final balance due from the owner is the sum of three hundred eighty thousand seven hundred sevenh• and <br />651100 Dollars <br />the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which <br />shall become effective 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 above -described <br />property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no <br />other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within <br />the scope of this affidavit and waiver. <br />Milestone Contractors North, Inc. <br />n Conway <br />Project Accountant <br />Subscribed and sworn to before me this: 22nd day of November, 2023 <br />Notary Public: <br />Alisha Krue r <br />My Commission Expires: June 5, 2030 <br />.... "�i <br />ALISHA KRUEGER <br />• `�; <br />My Commission Expires <br />County of Residence: La Porte <br />1*• SEAL :* <br />June 5, 2030 <br />Comrrdssion Number NP0653544 <br />La Porte County <br />
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