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17're 2 <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Engineerin2 Office Inn rovements. <br />PROJECT NO 118-107 FINAL COST $9 233.00 <br />CONTRACT SIGNED 11/27/2018 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Remodel of several offices aces in the En ineering Department <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 />Executed) this 23rd day of January <br />, 2019 Ziolkowski Construction Inc. <br />Company Name <br />Signatu 4050 Ralph Jones DrNe <br />Bill Favors/President & CFO Company Address <br />Printed Name <br />South Bend, IN, 46628 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Bill Favors , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 23rd day of JanurV 2019,.. <br />LYNN r)VINING <br />Seal <br />�� Notary Public-Stzteoflndiana Notary S6 i My Commission Expires March S, 20 y <br />Not._...... t1ik arr VVmty <br />Lynn D. ViningMy Commission Expires Mar6,2025 <br />Elkhart <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed, <br />1, Robert Bash certify that I am Secretary of the Corporation executing this release; that <br />B N Favors who signed this release on behalf of the contractor was then <br />Press en `CF <br />..""""" of said Corporation; that said release was duly signed for and on behalf of said <br />Corporator by tat rit� o "' Igerning body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Robert Bash Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />proval and we recommend to the Board of Public Works that it be ordained so. <br />This project Is acceptable r In I' Date: <br />P 1 p <br />Construction Mpar for <br />I' <br />BOARD OF PUBLIC WORKS APPROVAL Date, A% <br />Gary A. GUM, President tax Fritxberg,,,,NJWber kliz—a eth A. Mar'adIInber <br />Therese T Dorau, Member <br />Laura O'Sullivan, <br />M. Martin, Clerk. <br />