Change Order No 1 & PCA - Small Drainage Design and Repair Proj No 118-063 - Selge Construction

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CITY OF SOUTH BEND, INDIANA " BOARD OF PUBLIC WORKS �- PROJECT COMPLETION AFFIDAVIT " PROJECT NAME Small Draina a Design and Repair Diva PROJECT NO 118-063 FINAL COST $100„619.41 CONTRACT SIGNED _. _. ......... 12/20/2018 MAINTENANCE AGREEMENT ENDS Provide and install various stormwater drainage improvements along and near Hawbaker PROJECT DESCRIPTION Street, Olivia Circle, and Creekwater Lane including a pavement, curb, and sidewalk repair. WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. �. eked thi� day of June 201 9 3e1ge Con tru bon Co.„ Inc Company Name Signature 2833 S. 11th Street Company Address Printed Name Niles, MI 49120 Project Engineer City, State, zip WITNESSESS: Before me the undersigned Notary Public in and for said country and state, personally appeared RcbEX,L KWin a and acknowledged his/her signature to the above Project Completion Affidavit on the 3 d day of JLme 1201 9 N. MwP Notary Signa@tare My Commission Expires 07/25/2020 �NOTAR � MPUBLIC CO BSS ON Z Vicki Priest Berrien " Printed Name County of Residence � 71. 25 2020�^�* �, l be executed. 1, the Contractor is a Vicki APcorporation, the following cefica, certifythat tell am Secretary of the Corporation executing this releaz,�k -t�--P._ , who signed this release on behalf of the contractor was then 'rn,i�q,wt Praj ec of said Corporation; that said release was duly signed for and on behalf of said Co r o ation by Authority of it cpliaverning body, and is within the scope of corporate powers: 77 ° Secretary's Signatures Corporate Seal _Vicki A. Priest Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: Go Construction Eger Gary A. Gilot, President Therese J. Dor e . er BOARD OF PUBLIC WORKS APPROVAL Genevieve E. Miller, Member Laura O'Sullivan, Member Date: d 02 4 i tizabe . aradik„ Member M. Martin, Clerk