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Y NrP <br />d <br />CITY OF SOUTH BEND, INDIANA <br />of <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVITS <br />PROJECT NAME 100 Wayne Street Plaza and Streetsca e <br />PROJECT NO 116-047R FINAL COST $267,518.00 <br />CONTRACT SIGNED 12/12/2017 MAINTENANCE AGREEMENT ENDS <br />................. <br />Construct the plaza and streetscape improvements along Wayne Street and Michigan Street, at <br />PROJECT DESCRIPTION the Northwest corner of the facilit at 100 Wa ne Street. <br />.._.... <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 />19 Premium; Concrete Services, Inc. <br />Company Name - <br />WITNESSESS: <br />Before methe undersigned Notary Public in and for said country and stall <br />LcJG�I `IAIC/ and acknowledged his/her signature to the above <br />the day ofJ/1NUAk\,I ,201CL—. <br />Ng ary Signature My Commission Expire <br />Printed Name County of Residence <br />712 Richmond Street <br />Company Address <br />Elkhart IN 46516 <br />JANEE M TOWNER <br />!, personally apWAW PUBLIC <br />Project Completion SlEftit on <br />ELKHART COUNTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, 2026 <br />r C tMMISSION NO.710399 <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, C , certify that I am Secretary of the Corporation executing this release; that <br />1-3 -. i" who signed this release on behalf of the contractor was then <br />r' ""'" c <br />. " of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation b hority of its governing body, and is within the scope of corporate powers: <br />w <br />d"r ry's Signature <br />Corporate Seal <br />M <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptabl fo fs I approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Constr°ucti eager <br />BOARD OF PUBLIC WORKS APPROVAL Date:„s <br />114 'A <br />Gary A. Gi President S'uz r na M. Fritzberg, Member . xzabeth A.,,M radik„ Member <br />rese J, 06raLi, giber Linda M. Martin, Clerk <br />