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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME -Studebaker Museum Rooftop Unit Replacements <br />PROJECT NO 117-081 FINAL COST $162,298.00 <br />CONTRACT SIGNED 12112/2017 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Replace four RTUs on the Studebaker roof, Test and balance eciuiDment, <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 claims and demands whatsoever arising tinder 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 the abov Contract. <br />Executed this day of <br />201 Y B.C. Mechanical, Inc. <br />Company Name <br />Signature 882 Anderson Rd. <br />M , k,— e Company Address <br />Printed Narne Niles, Ml, 49120 <br />City, State, Zip <br />WITNESSESS: <br />ife � 'Jh undersigned Notary Public in and for said country and state, personally appeared <br />'tI and acknowiedged his/her signature to the above Project Completion Affidavit on <br />201 <br />the <br />d <br />Notar Signature My Commission Expires <br />Printed Name County of Residence 0 <br />If the iAintra r is a c9rporatio the following certificate will be executed, <br />1, „ wad certify that I am Secretary of the Corporation executing this release; that <br />U � KJ, fl p'), X who signed this release on behalf of the contractor was then <br />k, of said Corporation; that said release was duly signed for and on behalf of said <br />Cor oration by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature Corperate Seal <br />t-lo(,-t. <br />Printed Narne <br />DEPARTMENT or PUBLIC WORKS APPROVAL <br />This project is acceptable 'T0 f fi t approval and we recommend to the Board of Public Works that it be ordained so, <br />7 <br />,, ",A Z- , Date: 0� <br />ConstrUCtiO nager <br />BARD OF PUBC W LIORKS APPROVAL Date: <br />Al O. dw, <br />- — <br />Gary A. Gilot, President <br />Suzann@ M. Ffftzbe-rg, Miiber E FEa6e5 A. 'Maradik, Member <br />Therese J. D(brau, Member James A. Mueller, Member '--Lid M. Martin, Clerk <br />