HomeMy WebLinkAboutChange Order & Project Completion - R&R Excavating, Inc. - 2017 Demolitions Phase I, Division B - Project No 117-065, f
6
! y .
�«
e a \m* a « 2\% >)
(�\
\� � ��
n
HI
AlF
Final Waiver of Lien
State of Indiana, County of S t . Joseph SS.
William Loudin being duly &worn that he/she is the Vice President
(Name of Officer) (Title)
of R&R Excavating, Inc. having contracted with City of South Bend, Indiana
(Contractor) (Owner)
to:finishcertain materials and/or labor asfollows: Demolition & Site Restoration per Specifications
(Description)
for a project known as 2017 Demolitions, Phase 1, Division B; Project NO. 117-065
(Name of Project)
located at 416 W. Calvert Street, South Bend, Indiana
and owned by City of South Bend, Indiana
(Owner)
and doss hereby further state on the behalf ofthe aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the sum of
Daiwa ($ )
❑ receipt of which is hereby aolmowledged; or
❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver o€Lienwhloh is given
solely with respect to said amount, and which waiver shall be Offective only upon receipt of payment thereof by the
undersigned;
(FINAL WAIVER) that the final balance due ftm the contractor is the stun of
Sixty—three Thousand One Hundred Thirty—eight s 63,�38. 0
Thousand Dollars and Zero Cents
❑ noelpt of which is hereby admowledged; or
the payment of which has boon promised as the sole consideration foriltis Affidavit and Final Waiver of Lien which chaff
become effective onlyuponreceipt of stub paymont.
TBEREFORE, the undersigned waives and releases unto the Owmr ofsaid promises, any and all liens or claims whatsoever
on the above -described property and improvements thereon an account of labor or material or both, fltrnished b the undersigned
thereto, subject to limitations or conditions expressed herein, if any; and furffier certified that no other party has any claim or right to a
lien on account of any work performed or material fmished to the undersigned for saidprojec4 and within the scope oftbis Affidavit
and Waiver of ,len.
R&R Excavating, Inc. By
(Finn) (Authorized Representative)
STATE OFINDIANA ) William Loudin, Vice President
SS:
ST. JOSEPH COUNTY )
Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared _.William Loudin
and aolcntowledged the execution of the foregoing Affidavit and Waiver of Lion.
IN WITNESS WIiEIiEOF, Ihave hereunto aubscrlbed my name and affixed my official seal on the 24 th day of
October 2017 ,
Notary Publlo Signature
My Commission Expires; 9/28/2024
Rebecca S. Blackston
Residingin St. Joseph county, Indiana Notary Public Name ...
mn I I
LAI