Change Order and PCA - WWTP Degrit Yard Piping Proj No 123-031A - HRP Construction

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State of Indiana, County of St. Joseph SS: Nancy Knapik being duly sworn that he/she is the Vice President (Name of Officer) (Title) of HRP Construction Inc. — having contracted with City of South Bend (Contractor) (Owner) Demolition work, installation of sludge piping, and site restoration at the to furnish certain materials and/or labor as follows; Wastewater Treatment Plant (Deseripdon) for a project known as Wastewater Treatement Plant Yard Piping Improvements, Contract A, Project 123-031A (Name of Project) located at 3113 Riverside Drive, South Bend, IN and owned by City of South Bend (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier; (PARTIAL WAIVER) that there is due from the Contractor the aura of Dollars ❑ receipt of which is hereby aclatowledged; or ❑ the payment of which lies 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 WA1VEJt) that the final balance due from the contractor is the sum of Twenty Five Thousand Thirty Seven Dollars and Thirty Cents ($ 25,037.30) ❑ recelpt of which is hereby acknowledged; or ® the payment of which has been promised as the sole consideration for this Affidavlt and Final Waiver of Lien which shall become effective onlyuponreeeipt of such payment, THEREFORE, 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 Jim 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. HRP Construction Inc. BY (Fim) (uthoriz�io .Representative) STATE OF INDIANA ) Nancy Knapik, Vice President SS: 5T. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared Nancy Knapik and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my o eial seal on the 29th day of April 20 25 N Public Signature My Commission Expires: March 6, 2032 Residing in St. Joseph County, Indiana Cynthia L. Vanheste Notary Public Name �Z�f 3t uA.KZ A CyLanheste �G�hdla� Jo8l"W"�3 t 66�