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0 kVi <br /> kVALLEIf <br /> PAWN <br /> PAWN - <br /> 1! ! <br /> 880013th AVENUE EAST <br /> SHAKOPEE,MN 55379 II <br /> PHONE(952)445-8615 <br /> FAX(952)445:W55 <br /> www.valleypaving.com <br /> I <br /> RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS Ii <br /> Dated 13-Jul 2015 1 <br /> The undersigned hereby acknowledges receipt of the sum of: ! $1,100.00 <br /> CHECK ONLY ONE <br /> 1.) [ j as partial payment for labor,skill and material furnished <br /> I <br /> 2.) [ J as payment for all labor,skill and material furnished or to be furnished <br /> (except the sum of$ retainage or holdback) <br /> 3.) [Xj as full and final payment for all labor,skill and material furnished or to <br /> be furnished to the following described real property:(legal description, <br /> street address or project name) <br /> Full payment of$1,100.00 will be released to Warning Lites of Minnesota as <br /> full and final payment for the 2015 Centerville Overlay Project when <br /> Full payment Is received by the City of Centerville <br /> and for value received hereby waives all rights acquired by the undersigned to file or <br /> record mechanic's liens against said real property•for labor,skill or material furnished <br /> to said real property(only for the amount paid If Box 1 is checked,and except for <br /> retainage shown If Box 2 is checked). The undersigned affirms that all material <br /> furnished by the undersigned has been paid for, and all subcontractors employed j <br /> by the undersigned have been paid in full, EXCEPT: <br /> I <br /> THIS WAIVER WILL BE EFFECTIVE <br /> ViArnlngLes of Minnesota <br /> ONLY TO THE TOTAL DOLLAR AMOUNT <br /> OF PAYMENTS ACTUALLY RECEIVED, "4Ar';3 <br /> NOTE: If this instrument is executed by a <br /> corporation,It must be signed by an officer, 858M� g�g30 <br /> and of exectued by a partnership,it must �/[ 331U1 <br /> be signed by a partneT. <br /> teak RECYCLABLE - - - - - - -- - - -- - - - -A VETERAN OWNED COMPANY <br /> ANinnative Action/Equal Opportunity Employer <br /> J <br /> i <br /> 31 <br />