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450UTry aFN <br />CITY OF SOUTH BEND, INDIANA ° <br />BOARD OF PUBLIC WORKS w <br />PROJECT COMPLETION AFFIDAVIT <br />,sss <br />PROJECT NAME Wastewater Treatment Plant Belt Filter Press #3 Rehabilitation <br />PROJECT NO. 116-051 FINAL 187,665.00 <br />COST <br />CONTRACT 06/28/2016 MAINTENANCE AGREEMENT <br />SIGNED ENDS <br />PROJECT Rehabilitate and rebuild Dewatering Building Belt Filter Press #3 at the <br />DESCRIPTION Wastewater Treatment Plant <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 />Exzuted this 12th day of January 20 17 <br />y� Alfa Laval Inc. <br />Sifnature Company Name <br />Ken Medlin 10470 Deer Trail Drive <br />Printed Name Company Address <br />Houston, Texas 77038 <br />City/State/Zip <br />WITNESS <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared m ; <br />1 M�� and acknowledged his/her signature to the above Project Completion Affidavit Y o M <br />on the day of J, , z 201 -1 <br />Notary YSignature �4 My Commission Expires og • o S ao z o <br />3 w <br />SHea.,n.�� o <br />Printed Name .M y County of Residence lMnz s y o c z <br />z U <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, W t W AA a. Ca+P u" certify that I am Secretary of the Corporation executing this release; that° - <br />Ken Medlin who signed this release on behalf of the contractor was then <br />Market Unit Manager -Environmental of said Corporation; that said release was duly signed for and on behalf of <br />said Coppor400n} by Authority of its governing body, and is within the scope of corporate powers: <br />Corporate Seal <br />WM,1#M 4, G0t)POLI-4 <br />Printed Name <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 <br />ordained so. <br />f�caeeasf%1 / � Date: o/-d/-Zo/7 <br />v Construction Manager <br />BO RD OF PUBLIC OR APPROVAL Date: �r/y/� l 7 <br />ti <br />Gary A. Gi ot, Pr sident Suzanna M. Fritzberg, Member Ja es A. Mueller, Member <br />egt: <br />Elizabeth A. Maradik, Member Therese J. Dorau, ember inda M. Martin, Clerk <br />