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Summit Construction of Vero Beach, LLC <br />2837 Flight Safety Drive <br />Vero Beach, FL 32960 <br />FINAL WAIVER AND RELEASE OF LIEN OR CLAIM AGAINST BOND <br />The undersigned, in consideration of the FINAL payment in the amount of $16,767.40 <br />hereby waives and releases its lien and right to claim a Tien for labor, services or <br />materials furnished through 8/31/2014 to Summit Construction of Vero Beach, LLC to <br />the following property: <br />GIFFORD BALLFIELDS IMPROVEMENTS <br />4715 43RD AVENUE, VERO BEACH, FL 32960 <br />This waiver and release does not cover any retention of labor, services or materials <br />furnished after the date specified. <br />Lienor's Name: KEMPF'S SITE <br />DEVELOPMENT, INC. <br />Signature Ir \t •Atrix <br />03/1 1161.6 (5 -iacso,rex iSte--(CraVi? <br />Date Title <br />State of Florida <br />County of....1-6Cktr(ne(U('(_ <br />The foregoing instrument was acknowledged before me this' pl day of 1" `fir th <br />t- <br />, 2015 byJ-V' £ '- \!ne (r)if6Nho is personal) know 'or furnished the <br />following identification <br />IA - <br />Notary Public <br />til •� Rairlec_ <br />Note: This is a statutory form prescribed by Section 713.20, Florida Statutes (1996). Effective October 1, <br />1996, a person may not require a lienor to furnish a waiver of release that is different from the statutory <br />form. <br />133 <br />