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CONDITTONAL AFFIDAVIT, LIEN WAIVER AND RELEASE <br />1• With reference to const~uction of the Courthouse Square Project on the site at Court & gigh <br />Stree~, Salem, Oregon (the "ProJoct")~ the underaignod for value roaivod, acl~owledges thai, <br />when a check for S~~~r oD has bocu proP~riy endotsed and has ban paid by the bank <br />'`" upon wluch it is drawq it has bxn paid in full for all ]abor, s~vi <br />provide~ or transportsd in connection cvith the Pro'eci throu ~' ~~pmcat and matcrials <br />J 8h ~11-~ L 199~, <br />except retainage, if an3'~ and hcncby fully and unoonditionally waives and releas~s arry and all right <br />to payment, liens, claims of lier~ rights to lieq bond claim righis, ar any other claims or demands <br />for labor, secvicGS, equiPm~at, n3alerials provided or fransportod in oonnection with the Projeci <br />through said datt exccpt retainage, if anY~ and except: <br />2~ The affiant below does her~y swear and a~~i th~ ~~e }~ ~ a~ority to sign this document <br />on behalf of the undersigned oompany and that the undersigned oompany will PaY in full all of its <br />subcantractors, suppliers and consultants for labor~ servioes, a4uiPment, materials pnovided or <br />transported in connedion with the Projed th~ugh the date t~eferenced in paragraph 1 above. Tbe <br />undersigned affiant and company further acl~owledge that Ownu and its lenders or financing <br />sources ar~ relying on this Conditional Affidavit, Lien Waiver and Release in oonnedion with <br />Processing and authoriang funding requests for payment <br />Dated this ~_ ~y of ~ <br />199~. <br />Company; <br />By: <br />Title: <br />STATE OF OREGpi~ <br />County of Marion ) <br />The foregoing instn~t was aclmowledged before me this _~~ day of _~ ~i ~ <br />199~, by [if signed on behalf of an entity, complete e following: of <br />(insert name of Company) a <br />corporation) on behalf of the (insert type of entity, eg <br />(type ofendty).] <br />tary Public for Orcgon <br />y commission expires:~"~(,~~ ~~_p ~ <br />~ <br />~1 ~~- OfFICiAL SEA~ ` <br />.~' ,' ~ ~ ~~' <br />~~ ::t-Y REPfEE VJ/~ilS~YORTH ~ <br />\~~~ NOTARY PIJHi IC-oi3~GON <br />~ <br />r~ CU~~11i~S~OrJ ~lG. ::13075 <br />t,~Y COA~~ti~isstord ~XPiRES ~li~Jc 1, 2~02 <br />-~_~ --~ --:r --y~~--~_ ~--~ ~-_- <br />Form E.1 <br />