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Of50LTN Bet' <br />CITY OF SOUTH BEND, INDIANA e <br />BOARD OF PUBLIC WORKS =a <br />PROJECT COMPLETION AFFIDAVIT as <br />PROJECT NAME Oliver Plow Pergola <br />PROJECT NO 116-075 FINAL COST $22,000.00 <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />V1z1/zu11J MAINTENANCE AGREEMENT ENDS <br />Pergola replacement <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 />Executed this ID'"L day of -'-54J U A -� 201 "% C & S Masonry Restoration Inc. <br />_Q_1a r Company Name <br />Signature 3725 N. Foundation Court, Suite AB <br />Company Address <br />Printed Name South Bend, IN 46628 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, pers( <br />S re,Qe y) Z • u Lc_ S�` , and acknowledged his/her signature to the above Project <br />Q day �2p01. <br />Fj"7" ,a <br />Notary Signature My Commission Expires <br />Printed Name County of Residence <br />`l*= St Joseph C <br />spq� : � Commission a <br />If the Contractor is a corporation, the following certificate will be executed., <br />1, certify that I am Secretary of the Corporation executing this release; that <br />who signed this release on behalf of the contractor was then <br />of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is —s�.. acceptablefor final approval and we recommend to the Board of Public Works that it be ordained so. <br />VLU . Date: 1 z • 14 • l 4 <br />ConstructioCFanager <br />BOARD QF PUBLIC WORKS APPROVAL Date: % /Z cI b ! % <br />Gary A. Gilot, President -Suzanne M. Fri berg, Member E i abeth A. Mai <br />Therese J. Dorau, Member Jamis A. Mueller, Member 6da M� Martin, <br />Indiana <br />