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Change Order No 1-PCA - Ameritech Dr Pavement Improvements Project No 117-057A - Walsh and Kelly Inc
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Change Order No 1-PCA - Ameritech Dr Pavement Improvements Project No 117-057A - Walsh and Kelly Inc
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4/2/2025 1:23:40 PM
Creation date
12/12/2018 12:47:51 PM
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Board of Public Works
Document Type
Projects
Document Date
12/11/2018
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Final Waiver of Lien <br />State of Maria, County of St. Joseph <br />SS., <br />John Peisker <br />being duly Sworn that he/she Is the Vice President of Asphalt Operations <br />(Name <br />Of Walsh & Kelly, Inc. <br />hElvbg contracted with City of South Bend <br />(Contractor) ....... . .. <br />(Owner) <br />to bmi3h certaift.rimterials andfor labor as follows; Asphalt, Concrete and Pavement Marking <br />for a project ]mown as # 117-057A: Ameritech Drive Pavement Improvements <br />(Name Of Project) <br />located at Ameritech Drive <br />and owned by City of South Bend <br />(Owner) <br />and does hereby Anther state OD the behalf ofthe aforementioned subcoriftotor/suppiler: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />i - 0, <br />El receipt of which Is hereby acknowledged; or <br />El 1110 p0mant of Which has beery promised as the, sole consideration for this Affidavit and Phsal Of Waiver , Lionwilich is given <br />SOMY with respect to said utnowit, and which waiver SbAl 1)(1 effective only upon receipt of payrnant thereof by the <br />w4orsigned; <br />(FINAL WAIVER) that the final balance due kom, the contractor is the sum of 369,436.04 <br />❑ receipt ofwhiah is hereby admowledged; or <br />1110PRYPIOUt Of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lieu which shall <br />bect.unc efreetive, only j1poll receipt of such payment, <br />THEREFORE, the undersigned waives and releases unto the Owner of said prerolses, any and all liens or claims whatsoever <br />on flic above-dcscrlbPd propuly and imlwovelaarlis fljor =wait of labor or tnaterial or bolb, finnished b tiro undersigned <br />thereto, SuNject to limiffillons or 0011ditions oxpre& ;�,Wnd fbrffirx cartified -thatno other party has any cloirn or right to it <br />,, & <br />lion on account of any work performed or materw Anippiod, for saidprojec4 and within the sc, )e ofthis Affidavit <br />and Waiver ofLIen. <br />S <br />0 A A <br />Walsh & Kelly' Inc. <br />111110 <br />STATE OF MMA <br />ST, JOSEPH COUNTY SS: ....... <br />Before me, the undersigned, a Notary Pub rem 44NI County and State, personally appeared John Peisker <br />and acknowledged the execution of the foregoing Affidavit 6#*Alvar of Lion. <br />IN WYMESS WHEREOF' Ihavc hereunto subscribed ray name and affixed rfly:� ,cial 1on the of <br />November200 18 <br />'Sign , ture <br />My commission Expfros, June 07, 2023 <br />Amy Elizabeth Turpin <br />Realilffigin ,Indiana county, Marshall Notitry Public Name <br />AMY -1-12ABETH TURPIN <br />E <br />Notary Public, State of Indiana <br />Marshall County <br />Commission Expires <br />June 7, 2023 <br />
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