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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME <br />PROJECT NO. <br />CONTRACT <br />SIGNED <br />PROJECT <br />DESCRIPTION <br />Wastewater Treatment Plant <br />111-071 FINAL $5,110,540.51 <br />COST <br />12/20/2012 MAINTENANCE AGREEMENT <br />ENDS <br />Rehabilitate eight Primary Clarifier Tanks, chain and flight mechanisms, <br />process piping, SCADA automation, Hydrogritter, fire alarm, handrail. <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />Exec ted this day of Sept 20 16 <br />—� L.D. Docsa Associates, Inc. <br />Sig ure Company Name <br />Scott neVoll, Vice President 300 South 8th Street <br />Printed Name Company Address <br />Kalamazoo, Michigan 49009 <br />City/State/Zip <br />WITNESS <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />S Go fi be V011 and acknowledged his/her signature to the above Project Completion Affidavit <br />on the GG / day off Se.201. <br />(,, <br />Wtary Signature My Commission Expires a2 ' q/ "ao <br />t--In V) .yl/l.ac.Co rd <br />Printed Name County of Residence Ka I a ma zo o <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, ,e •I. e , certify that I am Secretary of the Corporation executing this release; that <br />S r rlPt 'ke.un /I who signed this release on behalf of the contractor was then <br />U : r <. P � e�' 'I-& ( of said Corporation; that said release was duly signed for and on behalf of <br />said Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secr tary's Signature <br />Les Lc_ G C 4— <br />Printed Name <br />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be <br />ordained so. <br />iJ 44G ^ 44 Date: <br />Construction Manager <br />BOARD OF PUBLIC ORKS APPROVAL Date: 1( R-2 0 � ( <br />1= k ✓`Ltd - <br />Gary A. Gilot, President David P. Relos, Wember James A. Mueller, Member <br />Elizabeth A. Maradik, Member Therese J. Dunaj Member a M. Martin, Clerk <br />