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nu4. r. cove J.-r.Jrn, onv ruu trvima ix anrrli 140.)000 r. <br />AFFIDAVIT AND WArVER OF LIEN <br />State of Indiana, Cotnty of St. Joseph SS: <br />Rachelle L. Dolniak being duty sworn that he/she is the president <br />(Name of Officer) (Title) <br />of ..Ritschard Bros.-, Inc. having cotit=tedwith City of South Bend, Dept. of Public Works <br />(Subcontractor/Supplier) (Contractor) <br />to furnish certain materials .and/or labor as follows: Demolition and Site Work <br />(Description) <br />for a project Imown as Martin Luther King .Jr. Center Demolition <br />(Name of.Proj6ct). <br />locatddat .1522 Linden- Avenue, South Berid, IN 46628 <br />and ownedby City. of South Bend <br />•(Owner) <br />and :does hereby"f iither.•state on the behalf of 6e aforementioned-subcontractor/supplidr. <br />(PARTTAI. WAIVER)• that-iberie' s due from.the Contractorth'e suni of <br />Dollars (S ) <br />❑ iecdipt of *hich. is hereby •acknowledged; or <br />❑ the -payment -of whieh-liaslden.prouused as the sole, consideration for .this Affidavit and Final Waiver of Lien which is giden. <br />solely vriTh respect ta.said amount, and which waiver'shall be effective only upon receipt of payment thereof by.the <br />undarsigzzied; • , .. .. • . . <br />r <br />QM4AL WAIVER) that the final balance.dne •from the'conttactor:is ithe.ium.bf <br />Fifteen Thousand. Six HundKed Four Doliars and'60/f00 ($15',604.60 ) <br />❑ receipt :of whnicb ' s-hereby•ack ao'vvledgcd; or <br />❑X 'he'pa tvhicli lies .been promised.as the sole consideration f6r:this Affidavit%aud Final Waiver of Lien which shall <br />become effective onl�r uprna ieceipt.of such payment. <br />THEREFORE, tho'undersigned waives an&ielease's unto the Owner of saidpremis6s, any and all liens or claims whatsoever <br />on the above-da'scn-bed property and •improvements ;thereon an account of labor or r ak&ial or both, famished b the undeisigned <br />thereto, stibje�f Co;limitatioz� or conditions exptessed-bere"m,:if any; and further•certified fiat no. other party has any claim or right to a <br />lien'oa account of anYW6rk performed or.material famHhed to the undersigned for said project, and. within the scope of this Affidavit <br />and Wairier•ol'Lien. <br />Ritschard Bros., Inc. .gym <br />(Rum) (Authorized Representative) <br />STAT$ OF iNDIANA ) <br />SS: <br />ST..JOSBPRCOUNTY <br />$efore me, fhe vndexsigned, allotary.Public,.k and;for•said County and State, personally appeared Rachelle L. Dolniak <br />and acknowledged the execution Oft <br />'� tbltd6 Affida-6t and Waiver of Lien. <br />IN WITNESS wHEREQP" I� {d ubscribed my nano and affixed my official seal on the 0 th day of <br />N.ORsmbP_r, 2023i�� <br />G Tq N6 Public Signature <br />My Commission Expires: G <br />Michaela Ritschard <br />Residing in S t . Joseph �'.� ....... is Notary -Public Name <br />