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,SOUiHg <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS ram° <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 12th Floor Remodel <br />PROJECT NO 116-125 FINAL COST $41,768.00 <br />CONTRACT SIGNED 12113/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Remodel of the 12th floor. Tear down and build of several walls, carpet, and paint. <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 />Execut ��__ ._ i� day of March , 201 7 Brown &Brown General Contractors, Inc. <br />Company Name <br />Signature 124 S. Elkhart Street <br />Eric Brown Company Address <br />Printed Name <br />Wakarusa, IN 46573 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the uBrowndersigned Notary Public in and for said country and state, personally appeared <br />Eric n and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 8th day of March 201 7 <br />®�sfLJ/'N <br />Notary gnaturerM My Commission Expires <br />Bradley A. Romine <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />3/1/2019 <br />St. Joseph <br />I, Benard W. Kreps certify that I am Secretary of the Corporation executing this release; that <br />Eric Brown who signed this release on behalf of the contractor was then <br />President of said Corporation; that said release was duly signed for and on behalf of said <br />Corpo tion by Authority fits gover i body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Corporate Seal <br />Benard W. Kreps <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable fforAAnal approval and we recommend to the Board of Public Works that it be ordained so. <br />UCX c Date: %j • G . 1-7 <br />ConstructlortgFinager /r <br />,n BOARD OF PUBLIC WORKS APPROVAL Date: 3/�4 )1 �1 (Z <br />LC + <br />Gary A. Gilot, President Suzanne M. Fritzberg, Member Elizabeth A. Maradik, Memb <br />Therese J. Dorau,pemVer James A. Mueller, Member Lin M. Martin, Clerk <br />