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(Name and address) Alpha Delta Phi 5747 South University Avenue, Chicago, IL 60637 $ (Name and address) The Chicago Society of Alpha Delta Phi 5747 South University Avenue Chicago, IL 60637 # ! % #

! 2001013 #


General Construction March 15, 2004

The undersigned hereby certifies that, except as listed below, payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished, for all work, labor, and services performed, and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or Owner's property might in any way be held responsible or encumbered. &

SUPPORTING DOCUMENTS ATTACHED HERETO: ' Consent of Surety to Final Payment. Whenever Surety is involved, Consent of Surety is required. AIA Document G707, Consent of Surety, may be used for this purpose X Yes Indicate Attachment No The following supporting documents should be attached hereto if required by the Owner: ' Contractor's Release or Waiver of Liens, conditional upon receipt of final payment. Separate Releases or Waivers of Liens from Subcontractors and material and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. Contractor's Affidavit of Release of Liens (AIA Document G706A).

(Name and address) H. B. Barnard 53 West Jackson Boulevard Suite 235 Chicago, Illinois 60604

BY: (Signature of authorized representative) Jim Barnard, Owner (Printed name and title) Subscribed and sworn to before me on this date:



Notary Public: My Commission Expires:

AIA Document G706TM ­ 1994. Copyright © 1982 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This AIA® ® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This draft was produced by AIA software at 20:55:50 on 05/25/2004 under Order No.1000120211_1 which expires on 5/25/2005, and is not for resale. User Notes: (1359513895)



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