Change Order No. 1-PCA - Fellows St. & Dubail St. Neighborhood Improvements - Fuerbringer Landscaping & Design

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Oq 60E1TN `�O. CITY OF SOUTH BEND, INDIANA E�d BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT,ro� PROJECT NAME Fellows Street and Dubail Street Neighborhood Improvements PROJECT NO 116-041A (Division B) FINAL COST $46,210.00 CONTRACT SIGNED 9/13/2016 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Remove trees and plant new trees alonq Fellows Street and Dean Johnson Parkwav 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 Standards of the City of South Bend which were a part of the above Contract. Executed t %30U day of 0V 201 b Fuerbringer Landscaping & Design, Inc. Company Name Signaattu" e 1 22530 Brick Road 1xr-, T Company Address Printed Name South Bend, IN 46628 City, State, Zip WITNESSETS: Before me, the undersigned Notary Public in and for said country and state, personally appeared 1`7uA der r , and acknowledged his/her signature to the above Project Completion Affidavit on the _&O day of 201�,_. -MC- !&&, Notary Signature My Commission Expires 6a r 4 kLIL'r m. mcte l.2,n II Printed Name County of Residence �7 , J6 =Wh If the Contractor is a corporation, the following certificate will be executed. I, certify that I am Secretary of the Corporation executing this release; that who signed this release on behalf of the contractor was then of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for fin I approval and we recommend to the Board of Public Works that it be ordained so. c °�/- Date: t z, C> • t G Construction Mal eager BOARD OF PUBLIC WORKS APPROVAL Date: / 2 L IC, Gary A. Grilot, President Suzanne M. Fritzberg, Member Elizabeth A. Maradik, Member Therese J.01orau, Member Jarris A. Mueller, Member nda M. Martin, Clerk