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State of Indiana, County of St. Joseph <br />SS: <br />Dustin P. Hilary ^ being duly sworn that he/she is the Director o_f_Estimating <br />(Name of Officer) (Title) <br />of Milestone Contractors North, LLC (F/K/A Inc.) having contracted with City of South Bend <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; Road Reconstruction <br />(Description) <br />for a project known as Neighborhood Infrastructure: Ford St. and Walnut St. Intersection <br />_ (Name of Project) <br />located at Ford St. and Walnut St. Intersection <br />and owned by <br />City of South Bend <br />(Owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />❑ receipt of which is hereby aclotowledged; or <br />❑ the payment of which lies been promised as the sole consideration for this Affidavit and Final Waiver of Lien which Is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />Owner <br />(FINAL WAIVER,) that the final balance due from the eontrawor is the sum of 73, 709.48 <br />Seventy -Three Thousand Seven Hundred and Nine Dollars 48/100 �$ <br />❑ receipt of which is hereby acknowledged; or <br />® the payment of which has been promised as the sole consideration for this AMdavit and Final Waiver of Lien which shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or both, fttrnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a <br />lien on account of any work performed or material f rnishod to the undersigned for acid , and Rhin the scope of this Affidavit <br />and Waiver of Liev. � <br />Milestone Contractors North, LLC (F/K/A Inc.) By <br />(Firm) (Authorized Reprascntetivo) <br />STATE OF INDIANA ) <br />SS: <br />ST, JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared Dustin P. Hilary <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />October IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the 16th day of <br />202 4 <br />Notary Public signature <br />My Commission Expires: 02/01 /2031 <br />"-- John Conway <br />Residingin _ LaPorte County, Indiana _ f Notary Public Name <br />U4"RY PGB/ JOHN CONWAY <br />SEAL • Dwnmission Number: NP0746553 <br />My Commission Expires <br />9�OF 1N0\P 02101/2031 <br />