Project Completion Affidavit - Cleveland Well Field Refurbishments Program Related Items Project No 118-021A - Peerless Midwest Inc

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bb'kS 1Y1 �yv CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT_ PROJECT NAME Cleveland Well Field Refurbishments - Program Related Items PROJECT NO 118-021A FINAL COST $145,244.00 CONTRACT SIGNED 4/9/2019 MAINTENANCE AGREEMENT ENDS The procurement, installation, and programming of programmable logic controllers (PLC) in Cleveland North and Cleveland South well fields, Hach CA-610 Fluoride Analyzer with Reagents in Cleveland North and Cleveland South well fields, and two V1 OK Chlorinators in PROJECT DESCRIPTION Cleveland South well field. 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. this o7� day of air Executed 201 Peerless Midwest, Inc. Company Name Si,gna ure 55860 Russell Industrial Parkway J e Company Address �LrML� R �.- dIj'j�M J Printed Name Mishawaka, IN 46545 City, State, Zip WITNESSESS: fore m ne �urera" ned Notary Public in and for said country and state, personally appeared , acknowledged his/her signature to the above Project Completion Affidavit on the • day of 201 Notar Signat tre My Commission Expires Printed Name County of Residence "`wt'""°j� *w r r� �'" E CATHY S. LA:Expires rx q _state ndiana * �e St, Joseph Coy 9EA� •' ." My Commission 4� If the ontract r is a proration th following certificate will be executed. 1, �j:" 5�ertify that I am Secretary of the Corporation executing this release; that S who signed this release on behalf of the contractor was then �•-= of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Sr'nature i �—° Corporate Seal r 1 Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for '•n pproval and we recommend to the Board of Public Works that it be ordained so, �" Date: • Construction er BOARD OF PUBLIC WORKS APPROVAL Date: t Gary A.�Gilot,resident Aeve E, Miller, M er Eluzabejta A. Marad'dk„ Member )/*� .. . ...... ........ . ......... - Therese J, dau Member ura S C ..... _ r ullivan, er �; h da M. Martin, Clerk