Change Order & PCA - JMS Facade Work Proj No 116-048R - HGR Group Inc

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CITY OF'SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME AS Facade Work PROJECT NO 116-048R FINAL COST $211,707.00 CONTRACT SIGNED 4/11/2017 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Construction of Storefront and Facade renovations at the JMS Buildi LTAM 0 1 xam: 0 9 am I The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. Exe -7 HGR Group, Inc. Company Name Signature 1932 Churchill Drive Company Address Printed Name South Bend, IN 46617 WITNESSESS: ad Notary Public in and acknowledged Printed Name City, State, Zip Alexandra Mitchell, Notary Public Comm. Expires Oct, 12, 2025 I said country and state, personally app Besides in St. Joseph Co., IN ;ignature to the above Project Completion Xornm. Number 706417 My Commission Expires County of Residence If the 0 + + Us a corporation, 41 followingcerflf,—I. will be executed. certify that I am Secretary of the Corporation executing this release; that who signed this release on behalf of the contractor was then of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Printed Name Corporate Seal DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable foFapproval and we recommend to the Board of Public Works that it be ordained so, Date: it. ku Construction I" r BOARD OIF PUBLIC WORKS Gary A. Gilot, Therese J. Dorau, Member James A. Mueller, Member 'AL Date: Eli—zibeth"AMaradik, Member Linda M. Martin, Clerk