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NQR�THWEST . <br />l <br />NORTHWEST ASPHALT, 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 Rights <br />The undersigned, SCHMIDT CURB COMPANY, INC. admowledges receipt of payment <br />from:North��tAsphalti,Inc: or its.sub oniractor (if applicable) in. the- amount of <br />$ Z FINA aymentfor all labor, materials, equipment <br />and services provided by the undersigned through the date hereof for the completion <br />of project listed: <br />** NATURES EDGE BUSINESS CENTER ** <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 maberial.paymentbond,ifany. provided. .by.NorthwestAsphalt Jnc. <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. , <br />BY: <br />rrs:�� <br />Failure to return this Iien waiver may delay future payments. <br />Page 79 of 201 <br />