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Change Order No 1-PCA - Navarre St Milling and Asphalt Overlay Project No 117-128 - Walsh & Kelly
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Change Order No 1-PCA - Navarre St Milling and Asphalt Overlay Project No 117-128 - Walsh & Kelly
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4/7/2025 11:02:23 AM
Creation date
1/24/2019 8:21:34 AM
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Board of Public Works
Document Type
Projects
Document Date
1/22/2019
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Final Waiver of Lien <br />State of Indiana, county of St. Joseph SS: <br />Dustin Hilary_ being duly sworn tbathe/sheisthe South Bend Area Vice President <br />(Name ofOfileer) (Title) <br />of Walsh & Kelly, Inc. haft contracted with City of South Bend <br />(Contractor) (Owner) <br />to furnish certain,materialsandlorlabor ssfollows; m w Asphalt Pavement and Marking <br />(,D�mrlpiion) <br />for a project known as _WM # 117-128: Navarre Street Milling & Asphalt Overlay <br />(Natrre of Project) <br />located at <br />and owned by <br />Navarre Street <br />City of South Bend <br />��._.T. <br />(Owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier.- <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />........... _...._.._... �.w ..._ . Dollars <br />❑ receipt of which is hereby acknowledged; or <br />❑ the paYment of~ hlch has been promised as the sole considoratlou for this Affidavit and Fivul Walver ofLlot —milch is given <br />solely with respect to said amorrrrt, and which waiver sbal,l be effective only upon receipt of payment thereof by the <br />rundersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of 16, 912.80 <br />❑ receipt of which is hereby adonowledged; or <br />91 the payment ofwhich has been promised as the sole consideration for this Affidavit and Final Waiver ofLlen which shall <br />becorno oMoflyo only upon receipt of such payment, <br />THEREFORE, the Underslgnud waives and releases unto the Owner of said premises joy and all liens or claims whatsoever <br />ort tlro above-deser°lbed proptaty and helm ovements th " ) ®punt of labor ormnterlot, th, ftrrnlshe o undersigned <br />therolo, subject to limitatlous or conditions ox rxas r t,rwd further cortll tb o other pax , s any claim or right to <br />lien on account of any work performed or metal igued fo eland jcot, and w the scope of this davit <br />and Waiver ofLien. o "• ». d <br />'"°" �_,.........,...�......_.�.�....,.. aserrtativo <br />y <br />Walsh & Kell, Inc. <br />STATE OF DIDUNA «� <br />ST, JOSEPH COUNTY ) �, IND\ <br />before <br />die undersigned, allota Pabli �� I6440llountya <br />� ;triStae� personally p�v Dustin Hilary <br />Ilforr•e Inc, <br />re execution oftho foragobig Affidavit mid Waiver ofI ion <br />1N WITNESS WHEREOF I have heremrnto subscribed ruy naino and affixed my offrc soul o the 21 st day of <br />December' 200 8 ... �. <br />.b_ .._ _._ _ . <br />. Not y Prrbllo�Slgrratot"o. <br />My Commission Expires: June 07, 2023 w � mm y .. h Turpin <br />Residm m Indiana C <br />Am Elizabeth <br />g _,_,,,,,Indiana county, Marshall t ail e a <br />Notary Public, State of liadians <br />armhaip Geun' ' <br />C,cmrna ss+on Expites <br />June 7, 2023 <br />.�ry <br />
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