Change Order No. 3-PCA -- Walsh & Kelly - Hill St. & Colfax Ave On Site Improvements

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WAIVER OF LIEN FINAL STATE OF INDIANA, ST. JOSEPH COUNTY: WHEREAS, the undersigned Walsh & Kelly, Inc. has been hereto employed by City of South Bend. Indiana to furnish certain material and labor, to -wit: Asphalt, Patching and Concrete for the building owned by City of South Bend, Indiana and located on Hill Street & Colfax Avenue On -Site Improvements South Bend, 46601 St. Joseph County, Indiana Protect # 113-033 _ NOW, THEREFORE, KNOW YE, That the undersigned, for a good and valuable consideration, the receipt of which is hereby acknowledged, hereby and now waives and releases unto the said Corporation, the owner of said premises, any and all lien, right of lien, or claim of whatsoever kind or character on the above described building and real estate, on account of any and all labor or materials, or both, furnished for or incorporated into said building by the undersigned; and we further certify t the consideration moving to the undersigned for executing this W F LIEN has been mutually given and accepted as absolute cas aym t and not as a conditional or part payment or as securitv,for pa ent. Signed, sealed and delivered this 20th / of ember 2016 f WALSH LL rC. Du 6outh Bend Area Manager Personally appeared l4fore me this 20th day of September. 2016 Dustin Hilary who being duly sworn on o13ath, says: That he is the South Bend Area Manager of the Walsh & Ke y, iric. and that he hereby acknowledges the execution tu of the foregoing instrne�t for and on behalf of said Walsh & Kelly, Inc. and at their special instance and;ruest. J I v My Commission Expires 08/29/2024 This instrument prepared by: JIH ody I. nines (Notary Public) JODY I. HAINES pnnnp, °•''•, Notery Public, State 0Indiana �e*i�"•� p : jotter; Elkhart County Commission # 600074 8 ''• rea My COmm1e910n Er ices 29, 2014 A000