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Rev. 05/18/16

EXHIBIT C

CONDITIONAL PARTIAL WAIVER OF LIENS AND CLAIMS,

AND AFFIDAVIT OF PAYMENT

For and in consideration of the sum of $__________________________ (“Current Payment”), which sum represents the total amount due and

payable to ______________________________________________________ (“Subcontractor”) for all work performed and materials and services

furnished in furtherance of the construction improvement project known generally as the ___________________________________________

Project located at ______________________________________________________________________________________________________,

____________________________ County, Ohio (the “Project”) through ___________, 20____ (the “Progress Billing Period”) which premises are

further known as JOB # _________ - ________________________________________________________ and when the check clears the bank

upon which it is drawn, Subcontractor unconditionally waives and releases any and all mechanic’s lien claims and/or attested account claims, rights

of mechanic’s lien and/or attested account claims, payment bond claims, and all other demands, damages, causes of action, and other claims of

whatever nature or description against John G. Johnson Construction Co. (“Contractor”), the Project owner(s), the Project, the project lessees,

Contractor’s payment bond surety, or any person or entity relating in any manner whatsoever to the Project to the extent of the Current Payment.

Subcontractor acknowledges and represents that the Current Payment represents full and final payment for all work, labor, materials, equipment,

tools and services supplied to or in furtherance of the Project (including without limitation extra work, fringe benefits, union dues, and impact claims)

through the Progress Billing Period, and that no additional sum is or will hereafter be claimed due by Subcontractor for such work, services or

materials against or from any person or entity, including without limitation the Project owner(s), the Contractor, the Project, Contractor’s payment

bond surety, or any Project lessee(s), with the sole exception of earned and unpaid retention.

Subcontractor further represents and warrants that it has paid all of its laborers, subcontractors, vendors, unions, and suppliers in full, or

that the proceeds of the Current Payment will be applied solely and exclusively to the payment of the persons or entities that have supplied labor,

materials, equipment, services or tools to Subcontractor for the Project to fully and completely resolve all of Subcontractor’s Project-related debts

through the Progress Billing Period. Subcontractor understands that the representations and warranties in this instrument are a material inducement

to Contractor’s release of the Current Payment to Subcontractor.

DATE: _________________, 20___

______________________________________________________

By: ____________________________

Its: ___________________________

State of ___________

)

) SS:

County of ___________

)

Before me, a notary public in and for said county and state, personally appeared the signatory hereof who signed the same in my presence, and who

acknowledged that he/she is authorized to and did sign the foregoing, and that the same was his/her free act and deed on behalf of

_________________________________________________, this ____ day of ________________, 20____.

__________________________

Notary Public

Conditional Partial Waiver Of Liens And Claims, And Affidavit Of Payment - Jgj Conditional Waiver

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