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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 <br />hereby waives and releases its lien and <br />materials furnished through 5/30/2014 to <br />the following property: <br />FINAL payment in the amount of $1400.00 <br />right to claim a lien for labor, services or <br />Summit Construction of Vero Beach, LLC to <br />GIFFORD BALLFIELDS IMPROVEMENTS <br />4715 43RD AVENUE, VERO BEACH, FL 32960 <br />This waiver and release does not cover any retention of labor, services or materials <br />furnished after the date specified. <br />Date <br />Lienor's Name: R.F. CONCRETE <br />CONST N,, INC. <br />Signature <br />Title <br />State of Florida <br />County of \v <br />The foregoing instrument was acknowledged before me this Z2j day of (Vial/ <br />, 2014 by 12D(\ who iersonally known furnished the <br />following identification <br />Seal <br />,...0"11.04, Notary Public Stale or Florida <br />Christy Shuthan <br />ornoMy Commission EE017547 <br />Expires 10/11/2014 <br />My commission expires: <br />Str_/$(_( <br />Notary Pub4tc <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 />