Project Completion Affidavit - West Race Emergency Repairs Proj No 115-115 - HRP Construction Co

Home Browse Search

AFFIDAVIT AND WAIVER OF LIEN State of Indiana, County of S t . Joseph SS: Nancy Knapik being duly sworn that he/she is the Secretary/Treasurer (Name of Officer) (Title) of HRP Construction Inc. having contracted with City of South Bend (Subcontractor/Supplier) (Contractor) to furnish certain materials and/or labor as follows: West Race Emergency Repair (Description) for a project known as West Race Emergency Repair (Name of Project) located at City of South Bend and owned by City of South Bend, (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars ($ ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and final Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of Thirteen Thousand Thre Hundred Fifty Five Dollars and no/100 ($ 13,355).00 ❑ receipt of which is hereby acknowledged; or (� the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective only upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever on the above -described property and improvements thereon an account of labor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit and Waiver of Lien. HRP Construction Inc. By �r� (Firm) (Authox ze-d-Representative) STATE OFINDIANA ) Nancy Knapik SS: ST, JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared n a n c y Knapik and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the 1 4 t h day of August 200 16 Notary Public Ignature Cindy V a n h e s t e My Commission Expires: 3 / B / 2 4 Residing in S t . Joseph County, Indiana Notary Public Name