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RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS <br />CONDITIONAL UPON RECEIPT OF PAYMENT <br />November 15. 2023 <br />THE UNDERSIGNED HEREBY ACKNOWLEDGES RECEIPT OF THE SUM OF $10,975.47 <br />FROM 0MG MIDWEST, INC. dba MINNESOTA PAVING & MATERIALS <br />CHECK ONLY ONE: <br />I) as partial payment for labor, skill and material furnished. <br />2) _x_ as payment for all labor, skill and material furnished or to be furnished (except the <br />sum of $571.58 retainage or holdback). <br />3) as full and final payment for all labor, skill, and material furnished or to be furnished to <br />the following described real property: (legal description, street address or project name) <br />JOB 4: 633990 <br />JOB NAME: Little Canada 2023 Street improvements <br />CONTRACT #: City Project # 23-01, 23-02, 23-03 & 23-05 <br />and for value received hereby waives all rights acquired by the undersigned to file or record <br />mechanic's liens against said real property for labor, skill or material furnished to said real <br />property (only for the amount paid if Box 1 is checked, and except for retainage shown if Box 2 is <br />checked). The undersigned affirms that all material furnished by the undersigned has been paid <br />for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: <br />Viking Restoration LLC <br />Matthew Richard Vickerman <br />NOTE: If this instrument is <br />executed by a corporation it <br />must be signed by an officer, <br />and if executed by a partnership, <br />it must be signed by a partner. <br />By3YO04 &(V - '--~ S~~ <br /> (Title)