My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
PCA - VPA Splashpad Renovations Proj No 123-044 - Premium Services
sbend
>
Public
>
Public Works
>
Board of Works Documents
>
2025
>
Project Completion Affidavits
>
PCA - VPA Splashpad Renovations Proj No 123-044 - Premium Services
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
7/21/2025 1:26:50 PM
Creation date
6/24/2025 12:14:46 PM
Metadata
Fields
Template:
Board of Public Works
Document Type
Projects
Document Date
6/24/2025
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
4
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
Show annotations
View images
View plain text
State af7ndiana, Gounty of ��%�� SS: <br />X�`_ �� �� bahtg duly sworn that he/she !s tho ail (� — Qi2�i �(.2f1,�' <br />{Name of ftloer) (Title) <br />f <br />:�� � :,� <br />for a project known as <br />having contracted with G p � , <br />(Owner) <br />and does hea�eby flusher state on the behalf ofthe aforemendoued subcontractorJsuppller; <br />(PARTIAL WAIVBR) that ther8 is due from Hio Contractor the sum of <br />Dollars ,�($ ) _� <br />❑ receipt of which is hereby acin►owledged; or <br />❑ the payment of which has been promised as the sole consideration fox this Af�dsvlt and Final Waiver of Llenwhlch is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt ofpaymentthereof bythe <br />undersigned; <br />�: � .� � �. <br />L V► ..�.�- .-� ,,� .�.� .•� �► �� �. � r <br />❑ receipt ofwhich is hereby eolmowledged; or <br />the payment of which has been promised as iha sole consideration for this Atliidavlt and Fiaa! Waiver of Lien whioh shalt <br />beoome offeotiva on;4y uponreceipt of suoh payment. <br />THBitRFORB, the undersigned waives and releases unto the Owner of said premises, any and al! liens or claims whatsoever <br />on the above -described property and improvements thereon au account of labor or material or both, t%rnished b the unders[gned <br />thereto, subject to limitations or conditions expressed hereia, if any; and further certified ihatno other party has any claim or right to a <br />lien on eccount of any work performed or material iitrnishad to the undersigned for said project, and within the scope ofthis Affidavit <br />and Walvcrofiiem. <br />'�� � <br />:, „� <br />.: . <br />~ _ 1 <br />a, <br />� r,, , t <br />., .� M , <br />SEAL <br />ELKHART COUNTY, STATE OF INDiANA <br />MY COMMISSION EXPIRES FEBRUARY 12, 2026 <br />COMMISSION NO.710399 <br />
The URL can be used to link to this page
Your browser does not support the video tag.