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CONDITIONAL AFFIDAVTT, LIEN WAIVER AND REI,EASE <br />With reference to const~uction of the Courthousc Square Project on the site at Court & ffigh <br />Streets, Salem, Onegon (thc "Projcd"). the underaignod for value noceived, aclmowledges thai, <br />whcn a chac3c for S~~~r Oa has bccn ProP~r1Y cu~rsod and has boen <br />upon wtuch it is cirawq it has been d in full for all labor servi F~ by thc bank <br />~ , ~, ~9~Pmcut and materials <br />provided or trac~ortcd in connxtion with the Projeci throuSh _~a7t-~ ~. 199~, <br />except ntainagc, if an3'. and ha+eby fully and unoonditionally waivcs and releases arry and all right <br />to paymcnt, liens, claims of liea, rights to lien, bond claim rights, or any other claims oc demands <br />for labor, sctvices, ~quiPment, materials provided or transported in connection with the Froject <br />through said daie exccpt ~tainage, if anY~ and e.xcept: <br />2. The affiant below does hereby swear and attest tha2 heJshe has full authority to sign this document <br />on behalf of the undersigned campany and that the undersigned company will PaY in full all of its <br />subcontractors, suppliers and consultants for labor~ services, ocIuiPment, materials provided or <br />transport.ed in connedion with the Projed thnough the date referenced in para~h 1 above. The <br />undersigned affiant and company furtha aclmowledge that Owner and its lenders or financing <br />sources are relying on this Conditional Affidavit, Lien Waiver and Release in connection with <br />Processing and authorizing funding requests for payment <br />Dated this ~_ day of ` <br />199~ <br />Company: <br />By: <br />Title: <br />STATE OF OREGOI~ <br />) <br />County of Marion ) <br />The foregoing insuu~t was acl~owledged before me this _~~ day of _~ ~i ~ <br />199-t-~ by [if signcd on behalf of an entity, complete e following: of <br />~ (insert name of CompanY) a <insert type of entity, eg <br />rporation) on behalf' op the (type of entity).] <br />tary Public for Oregon <br />y commission expires:y`~(,~ , ~ F~p ~ <br />,~>u.', OFFICIAL SEAL ~ <br />~~..-t'Y RENE[ 1~"Jl~~S~Y+~RTH ~ <br />\~~:y NOTARY PIJHLIr-oii~GON <br />rti CUhs~!~ll~s'7P~ ~1t1. ;;13015 <br />~,4Y C~A-14iISSl~f~ ~X°1RES Jl~+'Jt 1, 2C02 <br />- - -~ --:~~-~-~~.-~_ ~~:.: - - <br />Form E.1 <br />