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WAIVER AND RELEASE OF LIEN <br />UPON FINAL PAYMENT <br />The undersigned lienor, in consideration of the final payment in the amount of $10.00, hereby <br />waives and releases its lien and right to claim a lien for labor, services or materials furnished to <br />Johnson -Davis Inc. on the job of Indian River County BOCC (Owner), for improvements to the <br />following described project <br />Gifford Area Stormwater Project; Bid No.: 2018045 <br />Project No.: IRC -1502 <br />Indian River County, Florida <br />Dated On id. Vi r6 <br />Lienor's Name: Range Construction Industries Inc. <br />Address: -O, 60XX I Qts <br />�f kS's atm 2,91 <br />By: <br />Printed Name/ Title: <br />Sworn to and subscribe before me this 6CQ1th¢r y , 7,612) <br />6'i-e.5oh , <br />Si =nature of Notary Public Print Name of Notary Public <br />Commissioned State of Florida <br />Personally Known XX or, Produced Identification: <br />Type of Identification Produced: <br />ANO <br />Gregoda Estrella <br />NOTARY PUBLIC <br />STATE OF RARIDA <br />"144,:,..1,1,.`,.?;*- Cunnr*FF958335 <br />xpires 2/8/2020 <br />NOTE: This is a statutory fora: prescribed by Section 713.20, Florida Statutes (1996). <br />Effective October 1, 1996, a person may not require a lienor to furnish a waiver or release of <br />lien that is different from the statutory form. <br />109 <br />