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CONDITIONAL AFFIDAVIT, LIEN WAIVER AND RELEASE <br />With reference to const~uction of the Courthouse Squs~re Project on the site at Court & H'igh <br />Streets, Salem~ Oregon (the "Project'~, the undersigned for value reoeived, sclmowledges that, <br />when a cY~Clc for S_ '7/~75~/,G a has been propedy eudorsed and has been paid by the bank <br />upon wluch it is drawq it has been paid in full for all labor~ services, equipmeut and mateiials <br />provided or transported in connection with the Project through i~~~`~2('.Jf 31 , 199 4 <br />except mtainage, if any, and hereby fully and unoonditionally waives and releases any and all right <br />to payment, liens, claims of lien, rights to lieq bond claim rights, or any other claims or demands <br />for labor~ services, oquipment, materials pmvided or transported in conne~tion with the Project <br />through said date except r~tainage, if any, and except: <br />2. The affiant below does hereby swear and att~t that he/she has full auihority to sign this document <br />on behalf of the undersigned company and that the undersigned company will pay in full all of its <br />subcontractors, suppliers and consultants for labor, services, equipment, materials provided or <br />transported in connection with the Projed tluough the date referenced in paragraph 1 above. The <br />undersigned affiant and company further aclmowledge that Owner and its lenders or financing <br />sour~es are relying on this Conditional Affidavit, Lien Waiver and Release in connection with <br />processing and authoriung funding requests for payment <br />Dated this ~~ day of `~~i~~~n 199~. <br />company: M ~ <br />By: <br />Title: <br />STATE OF OREGOI~ <br />) ss. <br />County of Marion ) <br />The foregoing instiument was aclaiowledged before me this ~~ day of <br />199~, by [if signed on behalf of an entity, complete e following: of <br />('insert name of Company) a (insect type of entity, eg <br />corporation) on behalf of the (type of entity).] <br />~ <br />tary Public for Oregon <br />y co~;~sion e~ire~: ~c,th p I.~ob~, <br />- w.:~~~- ~-~t <br />~ -„~y~ OFFICIAL SEAL ,7~ <br />RENEE VI,+ADSI~~ofiTti yl <br />`''°~.r~..'` NOTARY PUBLIC C~;EG(~iJ ~Ir <br />COMMISSION N0. 3 ~ 3Glo <br />MYCOMMISSION EXPIRES JUtit 1, 2002 ~ <br />Form E.1' <br />