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•iir..NEN 1. g r 0D CONSTRUCTION LIEN The real estate subject to this lien is: PRAIRIE COMMONS SUBDIVISION LOT 1 QvkLo)',5 q ( 3533 Prairieview Street, Grand Island, NE ) 2. The person against whose interest in the real estate the lien is claimed is: GI Hospital Read Estates LLC 3533 Prairieview Street Grand Island, NE 68803 3. The name and address of the claimant is: Gerhold Concrete Company, Inc. 2625 South 158 Plaza Omaha, NE 68130 -1770 (402) 558 -2727 4. The name and address of the person with whom the claimant contracted is: CBS Piling Solutions Inc. 3403A NW Vivion Road Riverside, MO 64150 5. The general description of the claimant's services performed, to be performed, or materials furnished or to be furnished for the improvement and the contract price is: Concrete & concrete products $ 71,337.46 Plus Interest Charges Accruing at the Rate of 1% per month, 12% per annum, until paid in full. 6. (Complete one of the following): X The amount unpaid, whether due or not, to the claimant for services and/or materials is $ 71,337.46 The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of 7. (Complete one of the following): X The time of the last services or materials were furnished was: February 16, 2018 The time the last services or materials were furnished has not yet occurred but is estimated to occur GERHOLD CONCRETE COMP , URIC. STATE OF NEBRASKA ) )ss COUNTY OF Douglas ) The foregoing instrument was acknowledged Gordon A. Wellensiek of Gerhold Concrete Company, Inc. My commission expires: J dy 27 , Zozo Signature of Claimant before me this 23` day of May, 2018 , Credit Manager on behalf of said corporation. r CO c r( jd &JA , AMA A J o j61 Notary Public GENERAL NOTARY- State of Nebraska TIMOTHY S. BANDOW My Comm. Exp. July 29, 2020 rn c CO rfl cn o w co j 0,