Project Completion Affidavit - Century Center Upgrades and Renovations Project No 118-104AR - R Yoder Construction

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www. RYODERCONSTRUCTION. COM TEL: 574.773.3502 - FAx: 574.773.4941 R. "ODER CONSTRUCTION., INC,11 27453 CR 150 - PO Box 69 - NAPPANEE, INDIANA 46550 AFFIDAVIT AND WAIVER OF LIEN X FINAL PARTIAL PAYMENT TO FOLLOW On this date of August 27 , 20J_9 _in the State of Indiana, County of Elkhart Estabtuhed1978 W^^^^ W Jason Yoder being duly sworn states that he is President of (Name of officer) (Title) R. Yoder Construction, Inc. having contracted with City of South Bend to furnish certain (Owner) materials and/or labor for a project known as Century Center Upgrades located at 120 S Dr, Martin Luther King Jr. Blvd, South Bend, IN 46601 and owned by City of South Bend For the total amount of contract including extras is $ 104,180.00 of which R. Yoder Construction, Inc. has received payment of $ 98 971.00 prior to this payment. And does hereby further state on behalf of R. Yoder Construction, Inc.:. (PARTIAL WAIVER) that there is due from owner the sum of Dollars ($ ) . ( ) receipt of which is hereby acknowledged; or ( ) the payment of which has been promised as the sole consideration of this Affidavit of Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of such payment. (FINAL WAIVER) that the final balance due from the owner the sum of Five thousand two hundred nine dollars and no cents Dollars ($ 5,209.00 ) . ( ) receipt of which is hereby acknowledged; or (X) the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall become effective only upon receipt of such payment. THEREFORE, the undersigned waives and releases unto Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon the account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account to any work performed or material furnished to the undersigned project, and within the scope of this affidavit and waiver. R. Yoder Construction Inc. By /n�a President (Firm) (Au zed' Repr) (Title) WITNESS MY HAND AND NOTARIAL SEAL, this 27th day of Au uSt 2019 05-23-2027 (Notary Public) (My Commission Expires) Annette Wiseman ANNETT AISEMAN Notary Ptutft, Sp tO « Indiana (Printed name) Elkhart County_ Corllmtssion # NP�7 Ct4 S N MyOe 7Plac