PCA- 2023 Traffic Calming Divisions 1-5 - Selge Construction Co.

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Final Waiver of Lien Michigan State of>ld 0, County of Berrien SS: Justin Butler being duly sworn that he/she is the Vice President (Name of Officer) (Title) of Selge Construction Co., Inc. having contracted with City of South Bend (Contractor) (Owner) to furnish certain materials and/or labor as follows; Speed Tables (Description) for a project known as 2023 Traffic Calming - Project No. 122-014C _ (Name of Project) located at Throughout the City of South Bend and owned by City of South Bend (owner) and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier. (PARTIAL WAIVER) that there is due from the Contractor the 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 Final Waiver of Lien -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 One Hundred Thousand Five Hundred Sixty One Dollars and Fifty Two Cents ($100,W1.52) ❑ receipt ofwhioh is hereby aclamwledged; 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. TIiERBFORE, 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, furnished 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 furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. Selge Construction Co., tnc. By M ich i a n Tir1 `) (Authorized Representative) STATE OF�A ) Berrien ) SS: ti do,6rol�u COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared --Justin Butler and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. 10th IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my, f�i tal sea] on e, day of October 20o 2024 �8taryPublicSignature,•'`--.- My Commission Expires: 10/27/2027 NO' Pvauc'��►l'r'. car vrrar r3ertr�ieu'.3� Allison Swinehartr My min t Residingin Michigan County, Berrien Notary Public Name r Acting in the County of e f++r+ru a i o�titi�►ti��