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CONDTTIONAL AFFIDAVIT, LIEN WAIVER AND RELF.ASE <br />With reference to coasnudion of the Courthouse Square Project on the site at Court & H'ig6. <br />Streds, Salem, Oregoa (the "Project'~, the undersigned for value r~aceived, a~clmowledges that, <br />when a check for S t o8 ~ 803 . ao bas been properly cndorsed and has been paid by the bank <br />upon wluch it is drawq it has bcen paid ia fiill for all labor, secvioes, equipment and m3terials <br />provided or transported in oonaecxion with the Projed through (~(1o,~-c~ 31 ,1999,, <br />except retainage, if acry, and hereby fully and unconditionally waives and releases any and all right <br />to payment, liens, claims of liea, rights to lien, bond claim rights, or azry other claims or demands <br />for labor, secvices, equipment, maLerials provided or transporGed in oonnection with the Project <br />through said date exoept retaina8~ ~~Y. ~~P~ <br />2. The affiant below does hereby swear and aziest that he/she has full suthority to sign this document <br />on behalf of the undetsigned company sad tbat tho undersig4ad oompany will pay in full all of its <br />subcontcactors. suppliers and oonsulta~s for labor, seivices, oquiPment. mat.~ials Provided or <br />transported in connection witL the Projed through the date refec+en~oad ia paragraph 1 above. The <br />undersigaed affiant and oompaay further aclmowledge that Owner and its lenders or fiaancing <br />souras are relying on this Conditional Affidavit, Lien Waiver and Release in oonnedion with <br />processing and authorizing funding requests fur payment <br />Dated this 15+' day of Rpr"~ ~ 199 q. <br />Company: ~ ~ Cs+n - <br />By: <br />Tifle: <br />STATE OF OREGOI~ <br />) ~ <br />County of Marion ) <br />The foregoing instrument was ackaawledged before me this ~s^~" day of (Ylo,2~ <br />199q b__ _~'i1at~ S m~-1-~ ['if sigued oa behalf a~ aa entity, oomplete the following: of <br />1 ('~nse~t name of Company) a CcriJ • ('~nsert type of entit~', e8 <br />corporation) on behalf of the ~. (type of entity) J <br />OFFICIAL SEAt <br />MATTHEW L SI{AITH <br />, ,- FiOTARY PUBLIC - OREQON <br />COMMISSION N0. 903013 <br />MY COkSM1SSI0N EXPIRES JULY 14, 2001 <br />, <br />r <br />Notary Pubhc for gon <br />My commission expires: `i - t 4-'Z~ t <br />Form E.1 <br />~.... <br />