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CONDTTIONAL Ak~TDAVTT, LIEN WAIVER AND RELEASE <br />.,,~ 1. With reference to const~uction of the Courthouse Square Project on the site at Court & High <br />Stc~eets, Salem, Oregon (the "Projoct"). the undcrsigncd for valuc c~oceivod, ac1mowkdges that, <br />when a chxk for S~Q(~r OD has bccu properiy cndocs~ ~~~n ~ by the bank <br />upon which it is cirawq it has bacn paid in full for all labor, servias, equipmcut aad materials <br />providtd or transportcd in connedion with th,e Projed ttunugh _~o?1-6G 199~, <br />exa;pt netainagc, if anY, and hc~cby fully and unconditioaally waives and t~eleases auy and all right <br />to payment, liens, claims of lieq rights to lien, bond claim rights„ or any otha claims or demands <br />for labor, servias, oquiPmeai, materials providsd or transport~d in connxiion with the Project <br />through said daie except retainag0. if any. and except: <br />The affiant below does hereby swear and atiest that hc~~e ~~ authority to sign this document <br />on behalf of thc undersigned company and that the undersi~ company will PaY in full all of its <br />subcontractors, suppliers and consultants for labor, scrvioes, WuiPment, maierials pr~avided or <br />transpoct~ in connedion with the Projed thnough the date m.f'e.nenced in paragaph 1 above. The <br />undersigned affiant and company fiurtha aclmowlaige thai Owner and its lendus or financing <br />sources are relying on this Condidonal Affidavit, Lien Waiver and Releasc in connedion with <br />processing and authorizing funding requests for paymenC <br />Dated this ~_ day of ~ 199~. <br />Company: <br />By: <br />Title: <br />STATE OF OREGOI~ <br />) <br />County of Marion ) <br />The foregoing ins~t was ac~owledged befo~+e me this ~~ day af _~ t! ~ <br />199~, by [if signtd on behalf of an entity~ complete e following: of <br />(insert name of Company) a (insert type of entity, eg <br />corporarion) on behalf of the (type of enfity)•I <br />cary Public for Oregon <br />y commission Gxpires:~`~~ ( ~ ~~ ~ <br /> <br />- OfFICIAL SEAL ~ <br />r~°~yY <br />\~~:. <br />~ RENE[ VJAflS~Y{~RTH ~ <br />NOTAfiY PIJBLIC-Oft~GQrJ <br />r~ COh1.111SS::lPa ~1U. :'.13076 <br />t,~Y C~A•14iISSi~~~ ~X°1RcS ~li+lr 1, 2L'02 <br />- - - -~ -._-~~--~: =--~.~ - <br />Form E.1 <br />