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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2016 Downtown Partcin Garage Improvements <br />PROJECT NO 115-143 FINAL COST $1,228,684.00 <br />CONTRACT SIGNED 11/22/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Improve all elevators at Leiqhton and Wayne Street aaraaes. <br />JWT1k1i I*1-V: M <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, Isis 10th day of JailUary 201 Gibson -Lewis LLC <br />Company Name <br />Signature 1001 West 11th Street <br />Robert A.-Lingenfelter, President Company Address <br />Printed Name Mishawaka, IN 46544 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />obe t. A. iD,ggDf_e d acknowledged his/her signature to the above Project Completion Affidavit on <br />the/ °" day of JanU� 201 <br />, <br />Notary Signature My Commission Expires <br />Elizabeth A. Biddle <br />Printed Name <br />County of Residence <br />July 10, 2024 <br />St. Joseph <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 <br />Printed Name <br />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for Itn 1 approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Construction er <br />BOARD OF RUBLIC WORKS APPROVAL Date: F <br />Gary A. Gitot„'" resident a a r�tzberg„ m er Elizabeth A. Maradik, Member <br />Therese J. Dorau, Member ',--Laura O'Suttiva ber L(nda M. Martin. Clerk <br />