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CONDITIONAL AFFIDAVIT, LIEN WAIVER AND RELEASE <br />With reference to construction of the Courthouse Square Project on the site at Court & H'igh <br />Strcets, Salem, Oregon (the "Projact"). the undersigne~ for valuo received, ac3mowledges that, <br />when a cherk for S 108 ~ 803 . aa t~as been pmPerly cndorsed and has been paid by the bank <br />upon which it is drawn, it has been paid in full for all labor, services, equiPmeat and materials <br />pmvided or transported in connedion with the Projed through (~(1o.~c~ 3\ 199~ <br />except retainage, if anY, and hereby fully and unconditionally waives and releases any and all right <br />to payment, liens, claims of lien, rights to lieq bond claim rig~ts, or any other claims or demands <br />for labor, services, equiPment, ma~zials Provided or transported in oonnection with the Projed <br />through said date except retainage, if any, and except <br />The affiant below does hereby swear and attest tbat helshe has full authority to sign this document <br />on behalf of the undersigned company and that the undersigned compaay will PaY in full all of its <br />subcontractars. suPPliers and consultants for labor, seivices, «luiPment, materials provided or <br />transported in connedion with the Projed through the daLe referenced in paragraph 1 above. The <br />undersigned affiant and company furtha acknowledge tbat Owner and its lenders or financing <br />sources are relying on this Conditional Affidavit, Lien Waiver and Release in connedion with <br />processing and authoriting fundin8 requests for payment <br />Dated this l s'~" day of ~ p c'~ \ 199 q. <br />company: ~ 1 C~ G <br />By: <br />Tifle: <br />STATE OF OREGOI~ <br />) ~• <br />County of Marion ) <br />The foregoing instrument was aclaiowledged before me this 15~' day of (~la~ , <br />199~ b ft~a.'t~'"' S m~'1~'~'` [if s~g~~ on behalf of an entity, complete the following: of <br />('insert name of Company) a Cs~r,~ • (insert type of entity, eg <br />corporanon) on behalf of the C.or-~ . (type of entity).] <br />OFFICIAL SEAL <br />MATTHEW L SNitTH <br />NOTARY PUBUC - OREGON <br />COMMISSION N0. 303013 <br />IAY COMkIlSSION EXPIRES JULY 14, 2001 <br />r- <br />Notaty Pubhc for gon <br />My commission expires: '1- l 4-"z~ I <br />Form E.1 <br />