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AFFIDAVIT AND WAIVER OF LIEN <br />2 Final ❑ Partial F] Payment to Follow <br />STATE OF: Indiana <br />COUNTY OF: St. Joseph <br />Jennifer Brown being duly sworn, deposes and says that __he makes this <br />affidavit for and in behalf of MARTELL ELECTRIC, LLC which, having entered into an agreement with <br />City of South Bend ("Contractor") for the construction of 2016 Lamppost Program <br />on the premises of the owner located at various locations <br />states that, upon receipt of payment by Martell Electric from Contractor in <br />the amount of Four thousand two hundred eighteen & 75/100 Dollars, <br />(the "Payment"), which payment has been promised by Contractor and is anticipated by Martell Electric, <br />all material and subcontract, due and payable, will have been paid and all labor paid in full to the date of <br />this affidavit EXCEPT for: <br />CONTRACT <br />RETENTION S <br />Effective upon receipt by Martell Electric of the Payment, Martell Electric does waive and release unto the <br />owner of said premises, any and all lien, right of lien or claim of whatsoever kind of character on the <br />above -described building and real estate under the Statutes of the State of Indiana <br />relating to Mechanic's liens, on account of any and all labor, material, or both, furnished for or <br />incorporated into said building by the undersigned, up to this date. <br />Subscribed and sworn to before me, <br />on this 31st day of October, 2016 <br />Notary Public <br />My commission expires: 2/28/2023 <br />MARTELL ELECTRIC, LLC <br />(si ned) <br />Jennifer Brown <br />(Printed Name) <br />Vice -President <br />(Title) <br />R E N A B A L D W I N <br />$IHiY O ft(j1711� <br />Go,i,•.,y <br />•. SEAA. - <br />Cosani,.'; rJn A Gil L:GS4 <br />. <br />L4; Canro�u: r,on C;;Otra3 <br />Fobfuary 28, 2C28 <br />