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CITY OF SOUTH BEND, INDIANA e i <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Wastewater Treatment Plant Belt Filter Press #1 Rehabilitation <br />PROJECT NO. 118-019 FINAL $202,956.00 <br />COST <br />CONTRACT 04/24/2018 MAINTENANCE AGREEMENT 09/28/2021 <br />SIGNED ENDS <br />PROJECT Rebuild Dewatering Belt Filter Press #1 at Wastewater Treatment Plant <br />DESCRIPTION <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. I <br />l3xecu d this r (Mai! of January 220 19 <br />Signature <br />Larry Packard <br />Printed Name <br />..........._..._. ..._.. ......... _ <br />AM Laval Inc. <br />Company Name <br />10470 Deer Trail Drive <br />................ -.- ........ _.....__...... .... <br />- - <br />Company Address <br />Houston, Texas 77038 <br />City/State/Zip <br />WITNESS <br />Before me, the undersigned Notary Public in and for said country and state, personally appere <br />_ITQ� ,and acknowledged his/her signature to the above Project Completion Affidavi <br />on the two day of <br />Notary Signature My Commission Expires <br />Printed Name County of Residence --4 <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, WiW * cT, 60006 ' , certify that l am Secretary of of the Corporation executing this release; that <br />Larry Packard who signed this release on behalf of the contractor was then <br />Contracts and Bid Manager of said Corporation; that said release was duly signed for and on behalf of <br />said Corpora `on by lithority of its governing body, and is within the scope of corporate powers: <br />Si n ire Secretary's <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be <br />ordained so. <br />� Date: Of-ZS- 20/0 <br />(,,"Con gtruction Manager <br />H N N <br />r o M and <br />g to <br />N <br />W N m <br />m <br />¢ w <br />W 0. � <br />Now <br />— u <br />APPROVAL ateVA—irra <br />BOARD OF PUBLIC O <br />......... JA /I <br />ary ilot', President �%j . n a Frigberg, Member O'Sullivan, er <br />t <br />labet tc �. <br />E <br />h A. aradik' Member Therese J. Dorau Member I�n a M. Martin, .lerlc <br />