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EWA <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT GOMPLETIO,N AFFIDAVIT <br />PROJECT NAME 2017 Code Enforcement Remodel <br />PROJECT NO 117-117 FINAL COST $6,339,00 <br />CONTRACT SIGNED 11/1412017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Installation of two now walls, miscellaneous electrical, a,n(1_pq11ptiqg. <br />WITNESSETH: <br />The work Linder the above contract between the City of South Bond 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 />Excled this 16th day of Aprlo 201.8 Zlolkowskl Construction Inc. <br />Company Name <br />—§'sgnature 4060 Ralph Jones Drive <br />Bill Favors Company Address <br />Printed Name South Bend, IN, 46628 <br />city, State, Zip <br />WITNESSES& <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Bill Favors , and acknowledged his/her signature to the above Project Com DEBRA L JOHNSON <br />the 16th day of A it 201 6 Seal <br />7Notary Public - State of Indiana <br />M rs <br />Notary Signature My Commission Expires March, 27, T24 Marshall County <br />Mit Commission ExplFes Me 27, 2024 <br />Debra L. Johnson <br />Printed Name <br />County of Residence <br />if the Contractor Is a corporation, the following certificate will be executed, <br />Charles Lewis certify that I am Secretary of the Corporation executing this release; that <br />BRII Favors 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 />Co,,plr 'on by A hority of its, verning body, and is within the scope of corporate powers: <br />Secretary's Signature Corporate Seal <br />Charles Lewis <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable forfinapproval and we recommend to the Board of - Public Works that it be ordained so. <br />----f— NI�tbld Date: <br />Construction �.ta�er <br />BOARD OF PUBLIC WORKS APPROVAL Date, <br />G I ary A. Gild, President -Su7anna M. Fritzborg, Member Elizabeth A. Maradilk, Member <br />Therese J. Do(au, M&rnber J"7� A. Muellor, Member `Tlr�a M. Martin, ClerP <br />