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CITY OF SOUTH BEND, INDIANA41 <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT." <br />PROJECT NAME Fire Station 10 & 11 Equipment <br />PROJECT NO 118-108 FINAL COST $47,287.00 <br />CONTRACT SIGNED 12/20/2018 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Install Gear Extractor and Soap Dispensing Systems at Fire Stations 10 & 11.. <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 />ExeCu ,Q -* ------- a-y._ 201 g _ Herrman and Goetz, Inc. <br />Company Name <br />Si ature 226 a, Lafayette Blvd <br />La6y Cripe, P. 0. A. Company Address <br />Printed Name <br />South Bend, IN 46601 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />__,Larry„__QIL _, and acknowledged his/her signature to the above Project Completion Affidavit on <br />the day of 201�_. <br />Notary Signature My Commission Expires 7/13/2022 <br />Catherine J. Gruber <br />Printed Name <br />County of Residence It-- jaseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, Kathleen A. Herrman certify that I am Secretary of the Corporation executing this release; that <br />�L 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 />Cor or do by A t rAt f its governing body, and is within the scope of corporate powers: <br />Secretary's Signature Kathleen A. Herrman Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project Is acceptable for ' al approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: 4. 12t o t <br />Construction "er <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gilot, President Gea vieve E. Mi l r fOember Elizabeth A. Maradik, Member <br />herese X Cf6,rau, Member aura O'Sullivan, Member <br />da M. Martin, Clerk <br />