HomeMy WebLinkAboutInv# PAY APP#3 - MAN-CON, INCORPORATED - 07/31/2021 (2)PARTIAL RELEASE AND WAIVER OF LIEN
The undersigned lienor, in consideration of value received from City of Dania Beach,
hereby releases its lien and waives its right to claim a lien to the extent of
$ for labor, services, and/ or materials furnished through JULY 31, 2021
except (list exceptions) N/A to the property:
SOUTHEAST 2nd AVENUE AND SOUTHEAST 7TH STREET
WATER MAIN REPLACEMENT
ITB NO. 20-006
CITY OF DANIA BEACH
BROWARD COUNTY
FLORIDA
The undersigned certifies that all labor, services and or materials described herein have
been provided prior to the execution and delivery of this document.
Dated this, day of, , 2021.
MAN-CON, INC.
By:
(SIGNATURE)
Printed Name:
Title:
STATE OF: FLORIDA
COUNTY OF: ________________
BEFORE ME, the undersigned officer, personally appeared
as of
,Who is personally known to me or
presented as identification, and who did take
an oath, and who is known to me to be the person described in and who executed the foregoing
instrument, and acknowledged to and before me that he/ she executed said instrument in the
capacity and for the purposes therein expressed.
Signature of Notary
SEAL:
Printed Name of Notary . __
Broward
Anthony Mancini
Vice President Man-Con, Inc.
Kate Hill