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Box 1 <br />Box 2 <br />Box 3 X <br />21-086 <br />By: <br />Title: <br />NORTH ST PAUL, MN 55109 <br />PROJECT ADDRESS: <br />LITTLE CANADA <br />INVOICE or PAY APPLICATION: <br />Pay App #1 - #4 <br />For value received the undersigned waives all rights acquired by the undersigned to record <br />a mechanic's lien against said real property or to make any claim against any bond for labor, <br />skill or material furnished to said property (only for the amount paid if Box 1 is checked, and <br />except for retainage shown if Box 2 is checked). The undersigned affirms that all material <br />furnished by the undersigned has been paid for, and all subcontractors retained by the <br />undersigned have been paid in full. If paymet has been or is to be made by check, this lien <br />waiver is not valid until the check has cleared all banks. <br />CONTRACTOR: TA SCHIFSKY & SONS, INC. <br />ADDRESS: 2370 HIGHWAY 36 EAST <br />CITY OF LITTLE CANADA <br />RECEIPT AND WAIVER OF MECHANIC'S LIEN AND BOND RIGHTS <br />Dated: March 21, 2022 <br />The undersigned hereby acknowledges upon receipt of the sum of:$502,698.55 <br />From: City of Little Canada <br />CHECK ONLY ONE BOX OR BOX 1 WILL APPLY: <br />as partial payment for labor, skill and material furnished <br />as payment for all labor, skill, and material furnished or to be furnished (except <br />the sum of $ as retainage or holdback) <br />as full and final payment for all labor, skill and material furnished or to be <br />furnished <br />To the following real property: <br />PROJECT NAME: <br />VP of Construction