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NORTHWEST <br />NORTHWEST ASPHALTr INC <br />1451 Stagecoach Road * Shakopee, MN 55379 <br />Phone 952-445-1003 * Fax 952-445-1056 <br />Receipt and Waiver of Lien and Bond Claim Risrhts <br />The undersigned, SAFETY SIGNS LLC acknowledges receipt of payment <br />from Northwest Asphalt, Inc. or its subcontractor (if applicable) in the amount of <br />-r o Ok+ P" <br />13 76t3.o as PA1t��VFINAL ayment for all labor, materials, equipment <br />and services provided by the undersigned through the date hereof for the completion <br />of project listed: <br />13066 Orono Parkway <br />NWA JOB # 1255 <br />To induce Northwest Asphalt, Inc. or its subcontractor to make this payment, the <br />undersigned represents and warrants to Northwest Asphalt, Inc. and its subcontractor <br />that the undersigned has fully paid any and all of its laborers, suppliers and <br />subcontractors for labor, materials, equipment and services provided for the Project <br />through the date hereof. <br />In consideration of this payment, the undersigned waives and forever releases <br />(1) any mechanics' or other lien claims it has or may have against Northwest Asphalt, Inc., the <br />Project owner or the property upon which the Project is located, and <br />(2) any claim it has or may have against Northwest Asphalt, Inc. and Northwest Asphalt, Inc.'s <br />surety under the labor and material payment bond, if any, provided by Northwest Asphalt, Inc. <br />for the Project. If this is a partial payment only, this waiver release is effective only to the extent <br />of the payment received. <br />DATED: O 3 <br />BY: �� � �t& , I , Vak-) <br />ITS: �0) Laf <br />Failure to return this lien waiver may delay future payments. <br />Page 78 of 201 <br />