Laserfiche WebLink
CONDITIONAL AFFIDAVTT, LIEN WAIVER AND RELEASE <br />1• With reference to oonstiuction of the Courthouse Square Project on the site at Court & H'igh <br />Strceta, Salem, Oc~egon (the "ProJect"), the undersigned for value received, ac1mowledges thai, <br />when a check for S'7/,7s/,G ~ has bcen propedy endorsed and has been paid by the bank <br />`°-' upon wtrich it is drawn, it bas been paid in full for all labor~ seivices, equipmeut and materials <br />provided or t~ran.sported in oonn~tion with the Project through _t~y.~~ 31 ,199 4 <br />~cePt ~g~, ~~Y, and hereby fully and unoonditionally waives and releases any and all right <br />to payment, liens, claims of lien, rights tn lieq bond claim rights, or any other claims or demands <br />for labor~ sen+ices. oquiPment, materials pmvided or transported in oonnection with the Project <br />through said date except retainage, if any, and except: <br />The affiant below does hereby swear and atiest that hc/she has full authority to sign this document <br />on behalf of ihe undersigned company and that the undersigned comP~Y ~ PaY in full all of its <br />subcontractors, suppliers and consultants for labor, services, equipment, materials p~vided or <br />transported in oonnedion with the Projed through the date refenenced in paragraph 1 above. The <br />undersigned affiant and company further 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 authoriung funding requests for payment <br />Dated this ~[g_ day of '~<i~~i~it 199~ <br />company: M ~ <br />By: <br />Title: <br />STATE OF OREGOl~ ~ <br />) ss. <br />County of Marion ) <br />The foregoing inst~ument was acl~awledged before me this ~ day of <br />199~, by [if signed on behalf of an entity, oomplete e following: of <br />('insert name of Company) a (insert type of entity, eg <br />corporation) on behalf of the (type of enfity).] <br />i <br />N tary Public for Oregon <br />y commission expires: ~uti Q I.~ob~ <br />~ ~~~~~~ ~~.~ <br />:~,~ OFFICIAI SEA~ <br />~~ RENEE VUADSI,'~'G~TtI ;'I <br />f ~`~"~' NOTARY PUBUGC.;Er~;p~ ~~, <br />MY COMMISS~ION IEXP RES JU1;~3`~Ti j~ <br />1, ~00'l_ <br />~ - ~ <br />~. <br />Form E.1 <br />