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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME <br />2017 Engineering Remodel <br />PROJECT NO <br />117-116 FINAL COST $13,392.00 <br />CONTRACT SIGNED <br />11128/2017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION <br />Demolish existing kitchen and Install new cabinets, countertop, water cooler, and <br />plumb fixtures <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 dalms 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 Bond which were a part of the above Contract. <br />Ex:e2cu'ed this 16th - day of April 2018 Zloilkowski Construction Inc. <br />Company Name <br />44r�' <br />�J <br />Signature 4050 Ralph Jones Drive <br />Bill Favors Company Address <br />Printed Name <br />South Bend, IN, 46628 <br />City, State, Zip <br />WITNESSESS: <br />Before one, 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 Completion Affidavit on <br />161h April 6tho y <br />Notary Signature My Commission Expires March 27 <br />Debra L. Johnson <br />Printed Name <br />County of Residence Marshall <br />DEBRA L JOHNSON <br />Seal <br />q0tary public - Slate ot Indiana <br />lairsll uOunly <br />commission Exptr es Mar 27, 2024 <br />If the Contractor is a corporation, the following certificate will be executed, <br />1, Charles Lewis certify that I any Secretary of the Corporation executing this release; that <br />NO Favors who signed this release on behalf of the contractor was then <br />realdent of said Corporation; that said release was duly signed for and on behalf of said <br />Cor on by horltylis governing body, and is within the scope of corporate powers: <br />L It 7c, l� <br />Secretary's Slgnatune- Corporate Seal <br />Charles Lewis <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project Is acceptable for fi pproval and we recommend to the Board of Public Works that it be ordained so. <br />C'—= Datw ct - I <br />Construction tqjgYger <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gilot, President Suzanna M. FrItzberg, Member Elizabeth A, Maradlk, Member <br />Therese J. Do au Member Mueller, Member Li da M. Martin, Clerk <br />