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Final Waiver of Lien <br />Stale ofindiana, County of St. Joseph SS, <br />John Peisker being duly swomthathe/she is the Vice President of Asphalt Operations <br />(Name of Officer) (Title) <br />of Walsh & Kelly, Inc. having contracted Willi The City of South Bend, Indiana <br />(Contractor) (Owner) <br />toiitrttishcrawttrneteriatsandlorlabor asfollows.. Concrete Curb & Sidewalk and Brick Patching <br />(Description) <br />fnr nprojectkrtown as 2017 Curb & Sidewalk Div. A <br />(Name o0rojeot) <br />located at Various locations throughout the City pf South Bend, Indiana <br />and owned by The CitV of South Bend, Indiana <br />(owner) <br />and does hereby father state on the behalf of the aforementioned subca�ttractor/supplier: <br />(PARTIAL WAZVMR) that there is due from the Coolraotor the sum of <br />Dollars $ <br />❑ receipt of which is hereby aclmowledged; or <br />❑ the payment ofwhtch has been promised as the sole consideration for this Affldavlt and Final Waiver ofLlen Which is given <br />solely with respect to said ntnount, and which waiver shall be e0#'ec NO only Upon receipt ofpayment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the finat balama dlae from the contractor is the sum of <br />_ {$5,589.00 <br />❑ reoe€pt of which is hereby acimowledged; or <br />® thepaymarat of which has beenpromised as the sole consideration for flats Affidavit and Meal Waiver ofLien which shalt <br />become effeegve only upon receipt of such payment. <br />THIMFORE, the undersigned waives and release., unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon au account of labor or material or both, fltrttisited b tba undersigned <br />thereto, subject to limitations or eonditions expressed herein, � r d further certified thatno other party has any claim orrlglItto a <br />Pon on accoatnt of any work performed or material #tuui:�B�rO ; 1%uod for saldproject, and wlthlnCo sc afthis Affidavit <br />and WalverofLten. `% & <br />�� 5• :,ice , <br />Walsh & Kelly. Inc. �': o PO/gy <br />n) m `� Authorized Representative) <br />STATEU17ITli�IAN(Firm) <br />. -� ---- � � � o �.... : ' <br />ss; <br />., SEAL <br />sa' �os1Px cotlNrSr 0 <br />130fore me, the undersigned, a Notary Publi ft anq <br />and aolmowledged the execution of the foregoing Aida(OA <br />IN WITN13SS WUMOF, Ihave hereunto aubscrif <br />January <br />My Cotnmisaion Expires: <br />'Residing in Marshall <br />June 07, 2023 <br />county, Ilndiana <br />State,personailyappeared John Peisker <br />V&Y Nine and attired <br />Z01,4U13110 <br />Ste <br />igt200 —18 atwe11 th day pf <br />Amy Elizabeth Turpin, Staff Accountant <br />Notary Public Name <br />l_""TRPIN <br />WN'at�aryPublo, �fata or <br />NsrShall County <br />Commission Zjrer <br />4une 7, 2023 <br />