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Document G706 <br />Contractor's ATTldavit of Payment of Debts and Claims <br />PROJECT: (Name and address) <br />Fire Station No. 8 - S. Bend <br />2402 S. Twyckenham Dr. <br />South Bend IN 46614 <br />TO OWNER: (Name and address) <br />City of South Bend Board of Public <br />Works <br />227 W. Jefferson Blvd. <br />South Bend, IN 46601 <br />STATE OF: Indiana <br />COUNTY OF: Elkhart <br />ARCHITECT'S PROJECT NUMBER: <br />2172201870 <br />CONTRACT FOR: General Construction <br />CONTRACT DATED: <br />ARCHITECT: <br />CONTRACTOR: <br />SURETY: <br />OTHER: <br />The undersigned hereby certifies that, except as listed below, payment has been made in full and all obligations have otherwise <br />been satisfied for all materials and equipment furnished, for all work, labor, and services performed, and for all known <br />indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the <br />Contract referenced above for which the Owner or Owner's property might in any way be held responsible or encumbered. <br />EXCEPTIONS: <br />SUPPORTING DOCUMENTS ATTACHED HERETO: <br />1. Consent of Suretyto Final Payment. Whenever <br />Surety is involved, Consent of Surety is <br />required. AIA Document G707, Consent of <br />Surety, may be used for this purpose <br />Indicate Attachment ® Yes ❑ No <br />The following supporting documents should be attached <br />hereto if required by the Owner: <br />1. Contractor's Release or Waiver of Liens, <br />conditional upon receipt of final payment. <br />2. Separate Releases or Waivers of Liens from <br />Subcontractors and material and equipment <br />suppliers, to the extent required by the Owner, <br />accompanied by a list thereof. <br />3. Contractor's Affidavit of Release of Liens (AIA <br />Document G706A). <br />CONTRACTOR: (Name and address) <br />R. Yoder Construction Inc. <br />27453 CR 150 <br />Nappanee, IN ,465�5500 `) <br />(Signature authorized re esentative) <br />Jason Yoder, President <br />(Printed name and title) <br />Subscribed and sworn to before me on this date: <br />fpec"„GPn44-G, Zcpe�w <br />Notary Public: a,yt,(,w �WV�.4' ►1 vt <br />My Commission Expires: May 23, 2027 <br />ANNETiE WISEMAN <br />r 'x Notary public, State of Indiana <br />Eslshad Countyy <br />y0 F Comml ion # NP0720450 > My Commission Ex Ires <br />Me 23, 2027 p <br />AIA Document G706 —1994. Copyright©1970 and 1994. All rights reserved. "The American Institute of Architects,"'American Institute of Architects; "AIA; the <br />AIA Logo, and "AIA Contract Documents" are trademarks of The American Institute of Architects. This document was produced at 09:51:35 ET on 12/26I2024 <br />under Order No.2114509091 which expires on 02114/2025, is not for resale, is licensed for one-time use only, and may only be used in accordance with the AIA <br />Conlrad Documents®Terms of Service. To report copyright vlola0ons, a -mail tlocintoQaiaconiracts.com. <br />User Notes: (3B9ADA5D) <br />