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UNCONDITIONAL WAIVER AND RELEASE <br />NOTICE TO CLAIMANT: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOP <br />PAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY AND <br />STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS <br />DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU <br />HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL <br />WAIVER AND RELEASE FORM. <br />Identifying Information <br />Name of Claimant/Owner: J Y1 I..,r x. / breen .(o pyty t+ Ve"hxv"e-S , L-L <br />Name of Customer: City of South Bend <br />Job Location: i �� C� a fic' ` "j4l, J S i v✓ `�j` 'i ��Yt `�{� -.1t�� �e <br />Unconditional Waiver and Release <br />This document waives and releases lien, stop payment notice, and payment bond rights the <br />claimant has for all labor and service provided, and equipment and material delivered, to the <br />customer on this job. Rights based upon labor or service provided, or equipment or material <br />delivered, pursuant to a written change order that has been fully executed by the parties prior to <br />the date that this document is signed by the claimant, are waived and released by this document, <br />unless listed as an Exception below. Claimant and Owner hereby certify to City of South Bend <br />that all contractors/subcontractors constructing the sanitary sewer and water "Dedicated <br />Improvements" for the Job Location have been paid in full and there are no mechanics liens on <br />such infrastructure which is being dedicated to the City. Claimant and Owner hold the City <br />harmless from any claims related to this Waiver and Release. <br />Exceptions <br />This document does not affect any of the following: Q /4'i- <br />Disputed claims for extras in the amount of. $ 0 /, - <br />