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Of 50'UTNq a <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />ab, <br />PROJECT NAME <br />Century Center Masonry Restoration <br />PROJECT NO <br />115-015R FINAL COST $248,427.32 <br />CONTRACT SIGNED <br />10/13/2015 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having been <br />completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever <br />arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and <br />Standards of the City of South Bend which were a part of the above Contract. <br />Executed this 3 f day of 201�_. C&S Masonry Restoration LLC <br />Company Name <br />Signature 3725 N. Foundation Ct., Suite AB <br />Company Address <br />Printed Name South Bend, IN 46628 <br />City, State, Zip <br />WITNESSESS: <br />Before mee undersigned Notary Public in and for said country and state, personally appeared <br />y-he✓P r /�6 5 and acknowledged his/her signature to the above Project Completion Affidavit on <br />�o / MARSHA L. BROWN <br />thhe� — day of Lc ( 201-4-2— NOTARY PUBLIC <br />STATE SEAL <br />F INDIpA�NA z <br />Notary Signature o�l�l ♦ s5dfdl 4021 � _�y <br />14ate ' L Srot,J, s 12 <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, certify that I am Secretary of the Corporation executing this release; that <br />who signed this release on behalf of the contractor was then <br />of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Printed Name <br />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable foF final approval and we recommend to the Board of Public Works that it be ordained so. <br />e Date: L 14• • t Ce <br />Construction Hager <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gilo , President David P. Relos, MemWV Elizabeth A. Maradik, Member <br />01_ J. Dor� cga M. Martin, Clerk <br />tuber James A. Mueller, Member (�� � —� <br />Therese <br />tfn <br />