80513 | 05/26/2019 | Ad id: 1-0000427897-01

ADVERTISEMENT AND FINAL ACCEPTANCE FORM DATE: May 16,2019 TO: Spiegel Industrial, LLC. PO Box 773149 Steamboat Springs, CO 80477 You are hereby notified that the following advertisement for Final Payment appeared in a local newspaper dated May 28, 2019. "After thirty {30) days from May 28, 2019, Spiegel Industrial, LLC., CONTRACTOR. will be paid the full balance due on the Preparation and Coating of Filter Basins and Removal and Replacement of Filter Underdrains and Filter Media project, covered by Specifications No. 18-120.05. All persons having claims for labor, rentals, services, or materials furnished under this Contract, who shall not have been paid therefor, shall present the same to the OWNER in writing and verified prior to the date specified above, or the OWNER shall be free of all liabilities for attempting to obtain payment to such persons by the CONTRACTOR,, Subject to the terms of the Contract Documents, a Final Payment Check is attached hereto in the amount of Twenty-Nine Thousand Six Hundred and Twenty-Nme Dollars and Thirty-One Cents. ($29,629.31). Acceptance of which the CONTRACTOR thereby warrants that all persons doing work upon or furnishing materials for work under this Contract have been paid in full Failure to sign, approve, and return one (1) copy of this form or to protest within the (1 0) days constitutes proof of approval and acceptance by the CONTRACTOR of the final amount due under the Contract. OWNER: Carter Lake Filter Plant By: _______________ The final amount paid and the tenns and conditions set forth herein and in the Contract Documents are approved and accepted. CONTRACTOR: Spiegel Industrial, LLC. By: ________________ The Tribune May 26, 2019