Change Order No 1-PCA - 2018 Street Paving Project No 118-080 - Rieth Riley Construction Co Inc

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Final Waiver of Lien State of Indiana, County of St. Joseph SS: Joshua A. McCormick being duly sworn that he/she is the Sales Manager (Name of Officer) (Title) of Rieth-Riley Construction Co., Inc. having contracted with City of South Bend (Contractor) (Owner) to famish certain materials and/or labor as follows; Street Paving, (Description) for a project known as 2018 Street Paving 118-070 (Name of Project) located at Various locations in South Bend, IN and owned by City of South Bend (Owncr) and does hereby further state on the behalf of the aforementioned subcontractodsuppller: (PARTIAL WAIVER) that there is due from the Contractor the aura 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 ofpsyment thereofby the undersigned; (FINAL WAIVER) that the final balance due ftom the contractor is the sum of Five Hundred Eighty Thousand Two Hundred Ninet Three & 44 cents s580,293.4 ❑ receipt ofwhich 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. TMEFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or clairm,a whatsoever on the above-deserlbed property and improvements thereon an account of labor or material or both, fttmished b the undorclped thereto, subject to limitations or conditions expressed herein, Ifany; and fbrthcrcertifled that no other p as any clairr% ordgghtto a lien on account of any work performed or material furnished to the undersigned for said project d lth , a scope of°tl is Affidavit and Walver ofLlen. Rieth-R,ilev C nstructl n go, Inc. By� (Firm) ) (Auto ' res'cntative) STATE OF 1NDIANA Joshua A. M lck, Sales Manager ) SS. ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Joshua A. McCormick and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscribed may name and affixed my official seal on the 20th day of December 200 18 14— J o-fi ury Public Signature My Commission Expires: 10/22/18 Residing in St. Jose l County, Indiana Sue Anne Cira Notary Public No SUE ANNE Ctl'blt Seal Notsry Pwic - SUN of latliorrs St Jossph Cog* my Consmisslorw f tres Oct 22, 2022