Change Order-PCA - Indiana Earth - Demo of V & A Houses

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CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT °_\'\ISC5 y PROJECT NAME Demolition of Vacant and Abandoned Houses, Phase VII Division A PROJECT NO 115-117 FINAL COST $186,898.00 CONTRACT SIGNED 11/27/2015 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Demolition of Vacant and Abandoned Houses, Phase VI Division A WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standard a City outh Bend which were a part of the above Contract. Exe is of T-Lf Ly 201(, Indiana Earth, Inc. Company Name Signature 10343 McKinley Hwy mtq- %RI i Ifl � Company Address Printed Name ff Osceola, IN 46561 City, State, Zip WITNESSESS: �Nt1111ttttr� Before me, the nder gne Notary Public in and for say state, personally appeared nd acknowledged his/her s\gp ape Project Completion Affidavit on the r% day of v tr 201 SEAL = % Notary Signature f7pm ission Printed Name Couri(1f�' iS\`\ If the Contractor is a corporation, the following certificate will be executed. AA fi2,t 05lx7Z_ certify that I am Secretary of the Corporation executing this release; that e ,L .L o nP who signed this release on behalf of the contractor was then P77-eSi of said Corporation; that said release was duly signed for and on behalf of said Corpor ''r boutho i4p of sggerning body, aq is within the scope of corporate powers: .M�elL©�tx`�2, Sic, Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: '7 • 2 S • 1 4 Construction ktager BOARD OF PUBLIC WORKS APPROVAL Date: T 51,?4E Gary A. Gilot, Frresident DWvid P. Relos, MgMber Elizabeth A Maradik, Member Therese J. ucvau,Member James A. Mueller, Member in a M. Martin, Clerk