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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />W1ITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />2017 Brick Column Repairs <br />117-126 FINAL COST $11,493.00 <br />12/1212017 MAINTENANCE AGREEMENT ENDS <br />Re air of two neighborhood brick columns. <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 />Executed this dOf -11 201 C&S Masonry Restoration,, LLC. <br />w, . <br />Company Name <br />Signature 3725, N. Foundation Ct., Suite AB <br />'-(e,) -e- Q"Uk Company Address <br />Printed Name <br />South Bend, IN 46628 <br />City, State, Zip <br />WITNESSESS: <br />B f re me, too undersigned Notary Public in and for said country and state, personally appeared <br />Vf. L S , and acknowledged his/her signature to the above Project Completion Affidavit on <br />y of 201__,? <br />Notary Signature My Commission Expires <br />, ka- ar 1) VA <br />Printed Name County of Residence <br />N t MARSHA L, BROIL, <br />fir, <br />ot st juseph <br />5' 2021 <br />If the Contractor is a corporation, the following certificate will be executed, <br />1, certify that I am Secretary of the Corporation executing this release; that <br />who signed this release on behalf of the contractor was then <br />of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acce table for pproval and we recommend to the Board of Public Works that it be ordained so. <br />1� , r Date: ZA <br />ConstructiorI alter <br />BOARD, OF PUBLIC WORKS APPROVAL Date: A <br />Gary A. Gifot, President ulaWn&M" ritzb(*g iber Elizabeth A, Maradik, Member <br />Therese J. Dorau, Member James A. Mueller, Member llda M. Martin, Clerk' <br />