Project Completion Affidavit - Code Enforcement Office Improvements - Brown & Brown General Contractors

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Final Waiver of Lien State oflndiana, County of Elkhart SS: Eric Brown being duly awornthat he/she Isthe President (Name of Officer)(Title) of Brown & Brown General o Contractors, Incbavlttgcontractedwith City of South Bend, IN (Contractor) (Owner) to fmish certain materials and/or labor as follows; complete construction (Description) for a project lmown as Expansion of the Inspector area in Code Enforcement Office (Name of Project) located at South Bend, IN and owned by City of South Bend, Indiana (Owner) and does hereby further state on the behalf of the aforementioned subcontractor/supplier: (,PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars , ❑ receipt of which is hereby acluxowledged; or ❑ the Payment of wt,dlticch has been promised as the sole consideration for this Affidavit and Final Waiver of ien'which is given solely with respect to said atuouut, and which waiver shall be eftfeclive only upon receipt of payment thereof by the undersigned; (FINAL WAIVED that the final balance due from the contractor is the sum of Eight thousand eight hundred ninety-four and 00/100 dollars 8,894 00 ❑ receipt ofwhioh is hereby aclatowledged; or ® the Payment of which has been promised as the sole consideration ibr this Affidavit and Final Waiver of Lien which shall become offeetive only ttponrocclpt of such payment. THEREFORE, the undersigned waives and releases: unto the Owtmr ofsald promises, any and all liana or claims whatsoever on the above -described property and improvame"ts thereon as account of labor or material or both, fitruished b the undersigned thereto, sUb,)ect to limitations or conditions expressed herein, if any; and further certified that no other party has any cteim or right to a Jim on account of any wont performed or material ftunished to the undersigned for said p " ct ,, and withi scope ofthis Affidavit and Waiver ofLien, Brown & Brown General Contractors, Inc. ('�) (Ant a ed Representative) STATE OF INDIANA ) SS: ST. JOSEPH COUNTY ) Eefore me, the undersigned, a Notary Public, in and for said County and State, personally appeared Eric Brown and aclmowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, Ihave hereunto subscribed try name and affixed my official seal on the 28th day of June Zoo 2019 , Notary Public Signature My Commission;'ii'xpito; 4/3/2025 Residing in Marshall County, Todd A. Marek ............................. Indiana Todd AMara Notary PuNic o Pt�l SEAL Marshall County, State of Indiana My Commission Expires April 3, 2025