Project Completion Affidavit - Rum Village Dog Park Construction - R Yoder Construction Inc

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www ryoderconstruction com R. YODER CONSTRUCTION, INC. .m _ .... v.., �,....._..w. _�. _ ..._�_.. _�., w....n� __..,.,� a*W 1978 Tel: 574.773,3502 . Fax: 574.773.4941 27453 CR 150 . P.O. Box 69 Nappanee, IN 46550 AFFIDAVIT, RELEASE AND WAIVER OF LIEN ❑ Partial El Final Fi Payment to Follow On this date of November 1st 2018 in the State of Indiana, County of Elkhart Randall E. Yoder being duly sworn, states that he is President of R. Yoder Construction, Inc. having contracted with City of South Bend to furnish certain materials and/or labor for the project known as Rum Village Dog Park located at 2626 S Gertrude St, South Bend, IN 46614 and owned by City of South Bend for the total amount of contract including extras is $ 143,257.31 of which R. Yoder Construction, Inc. has received payment of $ 128,931.58 prior to this payment. And does hereby further state on behalf of R. Yoder Construction, Inc; AFFIDAVIT ❑ PARTIAL WAIVER There is due from Owner the sum of: Dollars $ ❑ Receipt of which is hereby acknowledged (unconditional); or ❑ The payment of which has been promised as the sole consideration of this Affidavit, Release and Partial Waiver of Lien which is given solely with respect to said amount and is effective upon receipt of such payment (conditional); El FINAL WAIVER The final balance due from Owner is the sum of: Fourteen Thousand Three Hundred Twenty Five Dollars and Seventy Three Cents Dollars $ 14,325.73 ❑ Receipt of which is hereby acknowledged (unconditional); or [D The payment of which has been promised as the sole consideration of this Affidavit, Release and Final Waiver of Lien which shall become effective upon receipt of such payment (conditional). 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 on account of labor, material and/or services provided by the undersigned, subject to the limitations or conditions expressed herein, if any; and further releases claims of any nature against the Owner. The undersigned further certifies that all parties who have provided labor, materials and/or services for said work have been fully paid, or will be fully paid out of the payment contemplated herein, if any, such that no other party has or shall have any claim or right to a lien on account of labor, materials and/or services provided to the undersigned for said project and within the scope of this Affidavit, Release and Waiver of Lien. I SWEAR OR AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE F REGOING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE. R. Yoder Construction, Inc President (Company Name) ( epre n rre Signature) (Title, please print) fore me this 1 St day of November 2018 (Day) (Month) (Year) 71v" PATRICIA KAY KAYLOR Patricia Kay4ylor Notary Public- Seal November 20, 2020 State of Indiana (Printed Name) My Commission Expires Nov 20, 2020 (My Commission Expires)