Change Order No. 2(FInal) & PCA - 2024 Brick Spot Repair - Acorn Landscaping LLC

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SUBCONTRACTOR/SUPPLIER AFFIDAVIT & WAIVER OF LIENS & CLAIMS Partial () Final ( X ) We, the undersigned, having been employed by The City of South Bend -("Contractor") to furnish labor, services, equipment and/or materials for construction work on the Project known as 2024 Brick Spot Repair Project, #124-041 constructed on real estate located in the County of St Joseph, in the State of Indiana, hereby warrant that the Contractor, any surety bond instrument or surety, any Project owner(s), any Project funds, and the Project real estate and the improvements thereon cannot be made subject to any valid claim, lien or encumbrance by anyone who furnished labor, services, equipment or materials to the undersigned for use in the Project, and the undersigned hereby waive and release any and all claims, liens and encumbrances of whatsoever kind or nature against the Contractor, any surety bond instrument or surety, any Project owner(s), any Project funds, and the Project real estate and improvements thereon for any labor, services, equipment or materials furnished through October 19, 2024. The above waiver and release are given in order to induce payment in the Amount Due of $6,454.25 and upon receipt by the undersigned of the Amount Due, the above waiver and release become valid, enforceable and of full effect. Upon attachment of the cancelled check and the legal description of the Project, this release may be recorded by the owner(s) or mortgage holder(s) of the Project. Notwithstanding the foregoing, the undersigned does hereby unconditionally waive and release any and all claims, liens and encumbrance of whatsoever kind or nature against the Contractor, any surety bond instrument or surety, any Project owner(s), any Project funds, and the Project real estate and any improvements thereon with respect to monies due the undersigned for previous payment requests in the total sum of $six thousand four hundred fifty four dollars and twenty five cents, the receipt and sufficiency of which is hereby acknowledged by the undersigned. c� Given under our hand and seal this Y0 day of AkV'/PA'YI &r 20 Acorn Landscaping, LLC Company Authorized Representative of Company STATE OF: lq4-CW& — COUNTY OF: Subscribed and sworn to before me this S4 day of /yoyW 20 zAV My Commission Expires: Noll Public County of Residence: 5J-J-0s EMD K. CONROY,FPRO010 Rev 1, 01/01/10 Publicent of St. Joseph Counssion No. NP0743631 '� ty INmission Expires 09/12/2030