PCA - Monroe Circle Demolition Proj No. 123-048 - Green Demolition Contractors

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Final Waiver of Lien State of Indiana, County of LaPorte SS: Michael J Brough . being duty sworn that he/she, is the President (Name of Officer) (Tide) of Green Demolition Contractos In&erg contracted with City of South Bend (Contractor) (Owner) to furnish certain materials and/or labor as follows: demolition ('Description) for a project known as Monroe Circle multi -tenant building demolition (Name ofProjeot) located at Monroe Circle and owned by City of South Bend (owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL. WArM) that there is due from the Contractor fhe sum of Dollars ($ ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Fined Waiver ofLien which is given solely with respect to said amount, and which waiver shall. be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of Seven t f usand four hundred seventy dollars and zero cents Y�?$ ❑ receipt of which is hereby acknowledged; or ® the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective only upon receipt of such payment. 'I'HBREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever on the above -described property and improvements thereon an account of labor or material or both, famished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a lien on account of any work performed or material famished to the undersigned for said project; and within the scope of this Affidavit and Waiver ofLlen. Green Demolition Contractors Inc By (Firm) (Authorized Rep tative) STAOVINDIANA ) 1 o rTt } SS: KPH COUNTY } Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared i c J rov and acknowledged the execution of the foregoing Affidavit and Waiver of Lion. IN WITNESS OF, I have hereunto subscribed my name and affixed my official seal on the S day of v�N� 202 o Public Sigiature My Commission Expires: Residing in Coutitys JANET M DOMMER Notary Public - Seal Porter County - State of Indiana Commission Number NP0746920 My Commission Expires Feb 16, 2031