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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKSID <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Potawatomi Zoo Parking Lot Expansion <br />PROJECT NO 115-129A FINAL COST $110,407.60 <br />CONTRACT SIGNED 10/11/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Parkino Lot Expansion at Potawatomi Zoo <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 />South Bend which were a part of the above Contract. <br />xecut d this 16th d�ji'u January 201 7 Ritschard Bros., Inc. <br />Company Name <br />Signature 1204 West Sample Street <br />Rachelle L. Dolniak, President <br />Printed Name <br />Company Address <br />South Bend, IN 46619 <br />City, State, Zip <br />WITNESSES: <br />Before me, the undersigned Notary Public in and for said county and state, personally appeared <br />Rachelle L. Dolniak and acknowledged his/her signature to the above Pr�gjpgjlqj mpletion Affidavit on <br />the 1 d y of Jan 2017 ; J\\coG .... , <br />NARL) 07• .( <br />� <br />Notar i nature M Commissionx ices '9 18y1i <br />Y 9 Y P : ^�. <br />Robin Fozo <br />N �• A <br />Printed Name County of Residepcl3s' GeLSxG JrSsegTi <br />If the Contractor is a corporation, the following certificate will be executed. '. <br />I, Donald Ritschard, Jr. , certify that I am Secretary rI4 cuting this release; that <br />chellit e L. Dolnia who signed this release on beh/ajt b� the contractor was then <br />test <br />o said Corporation; that said release was duly signed for and on behalf of said <br />and is within the scope of corporate powers: <br />Donald Ritschard, Jr. <br />Printed Name <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: I. G - l" i <br />Constructio pager <br />BOARD OF PUBLIC WORKS APPROVAL Date: a Imo% <br />Gary A. Gil , President <br />Suzanne M. Fritzberg, Member <br />A. Mueller, Member <br />E iza eth A. Maradik, Member <br />Ida M. Ma&Clerk� <br />