Change Order No 1-PCA - 2019 City Cemetery Paths - Acorn Landscaping

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PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION WITNESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT #NAME? 2019 City Cemetery Paths 1084-2019 FINAL COST 60„000.00 19 Resurfacino of MAINTENANCE - Phase 2 E The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of So d, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such c tract, and hat the contractor performed the work within the scope of the Specifications and Standards of the City of South end which ere a part of the above Contract. Execu d this ay of201 Acorn Landscaping Company Name 9 a raww rrrr� LINDA J GILROY 80 W Sample �atur Notary Public, State of 10dirar,I �� mpanyAddreSS J C _�1 St. Joseph County »* Printed Name aba�0. Commission Number NPC17Nrouth Bend, IN 46619 a�sMrrrr�zo My Commission July 31, 2027prres ut State, Zi y P WITNESSES& the JA 2 lay of 201. Notary Signature My Commission Expires Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. I, �._._............ _..................... .— certify that I am Secretary of the Corporation executing this release; that 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 Signature Printed Name Corporate Seal 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. Construction Manager , 1� A-` Date: BOARD OF PUBLIC WORKS APPROVAL Date: A, � � , Gary A. Gilot, President Genevieve Miller, Member Theresd J Dora ember , Laura O'Sullivan, Member Elpxabeth A. Maradik, Member Ld nda M. Martina 0 rk