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FINAL WAIVER OF LIEN AND RELEASE OF RIGHTS
<br />TO WHOM IT MAY CONCERN:
<br />The undersigned, who is the President of The Robert Henry Corporation
<br />which is the General Contractor for the improvements constructed or being constructed on the premises hereafter identified,
<br />declares that his contract with The City of South Bend, Board of Public Works is in the total amount of $ 1,259,278.00
<br />which includes extras and all change orders, on which he has received payment of $ 1,155,113.55 , prior to the final payment for
<br />which the undersigned has now submitted an application or invoice in the sum of $ 104,164.45 dated Jul 28 , 20 23 , the receipt
<br />and sufficiency of which said sum is hereby acknowledged by the undersigned.
<br />In consideration of the amounts and sums received, the undersigned does hereby waive and release to the Owner any and all liens or
<br />rights to liens upon said premises or upon improvements now or hereafter thereon, or upon the monies or other considerations due or to become
<br />due from the Owner or the General Contractor or from any other person, firm or corporation, said liens or rights to liens being on account of labor,
<br />services, materials, fixtures or apparatus heretofore furnished or which may be furnished at any time hereafter by or at the request of the
<br />undersigned. The premises as to which said liens or rights to liens are hereby released are identified as follows:
<br />Project Name: Southeast Neighborhood Center -United Way Address of Project: 405 E. Dubail Street
<br />City: South Bend County: St. Joseph State: Indiana
<br />Owner: United Way of St. Joseph Co. General Contractor: The Robert Henry Corporation
<br />The undersigned further represents and warrants that he is duly authorized and empowered to sign and execute this waiver on his own
<br />behalf and on behalf of the company or business for which he is signing; that he has properly performed all work and furnished all the material of
<br />the specified quality per plans and specifications and in a good and workmanlike manner, fully and completely; that he has paid for all the labor,
<br />materials, equipment and services that he has used or supplied or may hereafter use or supply to the above premises; that he has no other
<br />outstanding and unpaid applications, invoices, retentions, holdbacks, charge backs or unbilled work or materials as of the date of the
<br />aforementioned application or invoice; and that any materials which have been supplied or incorporated into the above premises were either taken
<br />from his fully -paid and open stock or were fully paid for and supplied as follows:
<br />(List the name of each party with whom you have a contract or purchase order to supply labor, and/or materials/equipment, showing the
<br />payment status under each contract or purchase order. Also show the value and status of labor, materials, and equipment you have furnished
<br />directly, listing your name as "supplier" in each such instance).
<br />CONTRACT PREVIOUS CURRENT BALANCE TO
<br />NAMES OF SUPPLIERS WHAT FOR PRICE PAYMENT PAYMENT BECOME DUE.
<br />All materials from
<br />fully paid stock.
<br />All labor fully paid
<br />TOTAL MATERIALS and
<br />LABOR to COMPLETE
<br />$ 1,259,278.00
<br />$ 1,155,113.55
<br />$104,164.45
<br />$ 0.00
<br />The undersigned further agrees and does hold harmless, reimburse and fully indemnify the Owner and The City for any losses or
<br />expenses should any such lien, claim or right to a lien be asserted, including attorney fees and costs.
<br />In addition, for and in consideration of the amounts and sums received, the undersigned hereby waives, releases and relinquishes any and
<br />all claims, rights or causes of action whatsoever arising out of or in the course of work performed on the above -mentioned project, contract or
<br />event, subject to and upon payment of a balance owing of $ 104.164.45
<br />Signed, sealed and delivered this day of , .20 4_.
<br />1) �j �p
<br />E (A1 l U t eprj4 (y Wd'XA t o. SEAL) t i � �y: � i
<br />(Individual or Corporake Name) (Signature)
<br />Title: I (1 t'� 12 _
<br />Subscribed and sworn to before me this 1 day of 1P OtUn ba
<br />Lyndsey Devens NOTARY PUBLIC
<br />Notary Public, State of Indiana Signature
<br />St. Joseph County
<br />Commission Number NP0749763 {
<br />MY Commission Expires
<br />June 26, 2031
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