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C� <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME North Station Filtration Plant Vessel #5 Raw Water SS Pipe Replacement <br />PROJECT NO. n/a FINAL $31,885.50 <br />COST <br />CONTRACT 07/12/2016 MAINTENANCE AGREEMENT n/a <br />SIGNED ENDS <br />PROJECT Demolition and Replacement of Water Treatment Process Piping <br />DESCRIPTION <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 />Executed thisftday of /�L' 20�. <br />Zimmerman Industrial Piping <br />Signature Company Name <br />/ZGy3LiZ%i®� /CE�ZSe-Ir 1117 Clay Street <br />Printed Name Company Address <br />Mishawaka, Indiana 46545 <br />City/State/Zip <br />WITNESS <br />� o me, the u dersigned Notary Public in and for said country and state, personally appeared <br />and acknowledged his/her signature to the above Project Completion Affidavit <br />on the At 2. day of Oec e r•vtey, 2016 <br />Notary Signah •e j My Commission Expires 1/1,7/.70 a <br />1�� U P y-1 v ,/ �i2 wo, it Cb / <br />Printed Name County of Residence '10 N yy <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, IZ&13L'➢Zi%E' lee See certify that I am Secretary of the Corporation executing this release; that <br />/Zta3L'2�3" le?-ZSZ-41 who signed this release on behalf of the contractor was then <br />/�/LESI �Je/vT` of said Corporation; that said release was duly signed for and on behalf of <br />said Corporation <br />nbbyyAuthority of its governing body, and is within the scope of corporate powers: <br />�J -� 4G <br />Secretary's Signature <br />126 /367v„ I, /Ge6n el-v Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This pr ject i acceptable for roval and we recommend to the Board of Public Works that it be <br />ore ed s <br />, ate: <br />Construction Managerth <br />BOARD OF PUBLIC W RKS APPROVAL <br />Date: /�2-/.,9- 1 /L <br />Gary A. Gilot, President Suzanna M. Fritzberg, Member <br />-071—� <br />Jarp es A. Mueller, Member <br />Elizabeth A. Maradik, Member Therese J. orau, Member h <br />