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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT f� <br />PROJECT NAME 2018 Curb and Sidewalk (Division 132)............ mm _ <br />PROJECT NO 118-007 FINAL COST $36,160.00 <br />CONTRACT SIGNED MAINTENANCE AGREEMENT ENDS <br />Remove and replace concrete sidewalk, curb, curb ramps, and approaches at various locations <br />PROJECT DESCRIPTION within the Citv of South Bend, IN. <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 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 />Exec, this y of 1 ,k6,P�' 201_ Premium Concrete Services, Inc. <br />Company Name <br />S nature' <br />Company " Address <br />Printed Nam <br />City, State, Zip I� <br />WITNESSES& <br />Before me, the undersigned Notary Public in and for said country and state, <br />.L:tA�"9 "I G4 K L--"q „ and acknowledged his/her signature to the above f <br />the R -tN day of ' E , 201_E_. <br />tary Signature My Commission Expires <br />Printed Name County of Residence <br />ect CompletiorJ NER <br />NOTARY PUBLIC <br />SEAL <br />COUNTY, STATE OF INDIANA <br />PIES FEBRUARY 12,2026 <br />If the Contractor is a qorporation, the following certificate will be executed. <br />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 />ll <br />°'' of said Corporation; that said release was duly signed for and on behalf of said <br />Corporatlo Authority of its governing body, and is within the scope of corporate powers: <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This proy acceptable for inc pproval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Constructi lager <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gilot, President Suz n �.rriitz�berg, ember Elizabeth A. Maradik, Member <br />�� <br />Therese J. Dorau, Mem er Jamesm�A. Mueller, Member t a M. Martin, C,P om .- . <br />tk <br />