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Final Waiver of Lien <br />State of Indiana, County of St. Joseph <br />SS: <br />John Peisker <br />boing duly &wom that lia/she. is the Vice President of Asphalt Operations <br />(Name of Officer) (Title) <br />Of Walsh & Kelly, Inc. having contracted with City of South Bend <br />(Contractor) <br />(Owner) <br />to famish certain materials and/or labor as follows: Asphalt, Concrete and Pavement Marking <br />(Description) <br />for a project known as # 117-041A: Downtown Cross Street Improvements <br />. . . . ........ <br />(Name of Projeot) <br />located at Downtown Cross Street Area <br />... ...... . <br />and owned by City of South Bend <br />(Owner) <br />and dDOS hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that them is due from the Contractor the, sum of <br />Dollars <br />El receipt of which is hereby acknowledged; or <br />El the PaY1,101it of'Which has been promised as, the sole consideration for this Affidavif and Final Waiver of Lieu which is given, <br />solely with respect to said amount and w1,11ch Waiver shall be cfrec4ivle only t1pon receipt of payajent thereof by the <br />andorsIgued; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of 87,694.31 <br />1:1 receipt of which is hereby acknowledged; or <br />X1 thepayincut of which 11'as been promised as the sole consideration for this Affidavit and.Final Waiver of Lien which shall <br />become offective only upolIxecelpt of such payment. <br />THEREFORE, the underslAilad waives arid, releases unto the Owner of said promises, any and all liens or claims whatsoever <br />on: the above-describedproperty and linjirovoniceijs flierq,(%Wjjjjyj t of labor ormaterial or both, funnislied b the undersigned <br />therolo, subject to lilnitAt[ons: or colidi6ons oXP1-Wscq ?d n a right �.O;jirfhcr cortifted thatno other plu-ty hats any claim or tto a <br />)"on on accollat of any work performed or niatoriull ;t;Itf thCW*iod (br said project, mid within n!)n of this Affidavit <br />and Waiver ofL!m <br />0 <br />C00' R'q <br />Walsh & Kelly, Inc. <br />(Authorized <br />STATE OF INDMNA SEAL. <br />SS: <br />A I <br />ST. 30SEPH COUMN 410 IND I <br />Before ine, the undersigned, a Notary Public, Z%tilij I: John Peisker <br />AiMAUUtY and State, personally appeared <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien, <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my offici e.,alonthe 7th _. day of <br />Jan ua�y.__._--- 200 <br />/Olaicy� IPTUblic Signature <br />My Commission Expires; June 07, 2023 <br />Residingin _.,, Indiana county, Marshall <br />Amy Elizabeth Turpin <br />Notary Pu <br />M. AMY EL12ABETH TURPIN <br />Notary Public, state of Indiana <br />Marshall County <br />Commission Expires <br />June 7. 202.1 <br />