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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Wastewater Treatment Plant Belt Filter Press 42 Rehabilitation <br />PROJECT NO. 115-082 FINAL 183,087.00 <br />COST <br />CONTRACT 09/22/2015 MAINTENANCE AGREEMENT <br />SIGNED ENDS <br />PROJECT Rehabilitate and rebuild Dewatering Building Belt Filter Press 92 at the <br />DESCRIPTION Wastewater Treatment Plant <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 />Execut d this 14th day of September 20 16 <br />Alfa Laval Inc. <br />iture <br />Sign Company Name <br />Ken Medlin 10470 Deer Trail Drive <br />Printed Name Company Address <br />; o <br />Houston, Texas 77038 <br />w N N <br />City/State/Zip <br />m o d <br />WITNESS <br />Before me, the undersigned Not Public in and for said coup <br />gn Notary try and state, personally appeared <br />m m <br />M V <br />Ken Medlin and acknowledged his/her signature to the above Project Completion Affidavit <br />a x <br />on the to , m day of �-r�".,y, 2016 <br />w > <br />o z <br />Notary nature Si — <br />g My Commission Expires cq . o <br />z <br />"oHt�l <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, W t t-t-t A-m S- O�Na o� y , certify that I am Secretary of the Corporation executing this release; that <br />Ken Medlin who signed this release on behalf of the contractor was then <br />Market Unit Manager - Environmental of said Corporation; that said release was duly signed for and on behalf of <br />sa�iJd C�,or�p/o atio by Authority of its governing body, and is within the scope of corporate powers: <br />y"t/�� -. <br />Secretary's inature Corporate Seal <br />Printed Name <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 />API 4&,U4 °cR Date: .07-/%- Z0/6 <br />UConstruction Manager <br />B ARD OF PUBLIC ORKS APPROVAL Date: <br />n <br />Gary AA Gilot, President David P. Relos, Member <br />-20/r-, <br />A. Mueller, Member <br />Member Therese J. Dordu, Winber "Vinda M. Martin, <br />