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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />Century Center Kitchen Door Installation <br />118-036B FINAL COST $17,975.11 <br />7/24/2018 MAINTENANCE AGREEMENT ENDS <br />Install a kitchen door entrance to the A-B Convention Hall <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 />Larson Danielson Construction Company, <br />Executed this 29th da of January 201 9 Inc. <br />Company Name <br />Signature 4 302 Tyler Street <br />--Timothy F. Larson, President Company Address <br />Printed Name LaPorte, IN 46350 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Timothy F. Larson , and acknowledged his/her signature to the above Project CompN :Expires <br />the 9 h da f Januar ,2019 .'hOTA"%'La PorTHY ,y :�"� nona��.; La Porte CMy Commissio <br />February 1Notary SignaturMy Commission Expires Februa'r <br />Cathy A. Sale 679923 <br />Printed Name <br />County of Residence LaPorte <br />If the Contractor is a corporation, the following certificate will be executed.. <br />I, Terry A. Larson , certify that I am Secretary of the Corporation executing this release; that <br />Timothy ITITF _ Larson_ who signed this release on behalf of the contractor was then <br />pt of said Corporation; that said release was duly signed for and on behalf of said <br />Corp t" n b Au only of its governing body, and is within the scope of corporate powers: <br />Secretary's Si natur )ZLc,-AC V NI L <br />'or orate Seal <br />_ Terry A. Larson st��dN Cn, INC. <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for~ f' I approval and we recommend to the Board of Public Works that it be ordained so. <br />L'o �70 Date: <br />t <br />Constructio gel <br />.f <br />BOARD OF PUBLIC WORKS APPROVAL <br />Gary A. GNlot, President <br />&w <br />T ereseJ. <br />Date: 1 0" �,-/ 0 l <br />Jz— <br />Elf—z9beth A. Maradik, Member <br />LihA M. Martin, Clerk <br />