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PROJECT NAME <br />PROJECT NO <br />116-091 <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />Plaza Parkino Garage Vent Pan RenInvPment <br />e <br />CONTRACT SIGNED 9/27/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Replacing 3 Ceiling Vent Pans <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend which were a part of the above Contract. <br />4Exe&cut this day �( t P , 201 0 Slatile Roofing and Sheet Metal Inc. <br />uPU�qCompany Name <br />R/,g+nature 4 `P,. C 1703 S. Ironwood Drive <br />/.�� ��' f L O Atl e r o� ��Qg/ D °f/ Eompany Address <br />it ted Name = $EPA SDUth Bend, IN 46613 <br />= Gity, State, Zip <br />WITNESSESS: <br />Before me the undersi ned Notary Public in and for said'sgyf�4�jt 6fd� t personally appeared <br />, and acknowledged his/her signature fb'theoatiove Project Completion Affidavit on <br />the y of e c 201 t o <br />N tary Signature My Commission Expires Lou Ann Ward <br />�.�„ Notary Public for the State Of IN <br />a • <br />Printed Name Count of Residence County of Residence- Elkhart <br />Y Exolres 9/1/2021 <br />If th Contractor is a corporation, the following certificate will be executed. <br />I, Lz �a r certify that I am Secretary of the Corporation executing this release; that <br />e.Q.Ap o who signed this release on behalf of the contractor was then <br />SZof said Corporation; that said release was duly signed for and on behalf of said <br />Cyfpration by Aupority of its goy@rning body, and is within the scope of corporate powers: <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 ordained so. <br />Date: 12 • t 3 14 <br />Constructio nager <br />Date: ti % //- /1/ 7 <br />WA <br />M. Martin, <br />