HomeMy WebLinkAboutInv# APPLICATION 3 - IMS CONTRACTING, INC. - 04/22/2022 (5)WAIVER AND RELEASE OF LIEN UPON PARTIAL PAYMENT
The undersigned lienor, in consideration of the partial payment in the amount of _____________
hereby waives and releases its lien and right to claim a lien for labor, services or materials
furnished to City of Dania Beach on the project of __Dania Beach Pier
Replacement_____________________ to the following described property:
100 W Dania Beach Blvd, Dania Beach, FL 33004
Dated on: 3/25/2022
Lienor's Name:
Address:
By:
Printed Name:
___________________________________
___________________________________
STATE OF MICHIGAN
COUNTY OF ____________
The foregoing instruments was acknowledged before me by mean of [how the individual appeared; check on]. □physical presence or □online notarization this _____ day of , 20___, by
(name of person making statement).
Signature of Notary Public-State of Michigan
Printed Name
Personally Known ______ OR Produced Identification _______
Type of Identification Produced_______________________________________________
NOTE: This is a statutory form prescribed by Section 713.20 Florida Statutes (1996). Effective
October 1, 1996, a person may not require a lienor to furnish a waiver or release of lien that is
different from the statutory form.
Industrial Maintenance Services, Inc.
1920 20th Ave N
Escanaba, MI 49829
Kayla Martinucci
Delta
March 22
Kayla Martinucci
Tammy M. WilesDelta
This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.
25th
$ 135,366.01