Change Order No 1-PCA - Small Drainage Design and Repair Project No 118-063 - GE Marshall

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,"'i Woo CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT AMA PROJECT NAME Small Drainage Design and Repair DivA PROJECT NO 118-063 FINAL COST $117,106.53 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 any pavement, curia, 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, d that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend wl1ch were a part of toCoNe Contract. 8th day ture Fran' „;. Marshall, Presiden 2019 _ G.E. Marshall Inc. Company Name 1351 Joliet Rd. Company Address City, p +i P'rinte rive Valparaiso, IN 46385 `��111 111 State, Zip �� '"��M`�'`�,�s . WITNESSESS: .'d� », Before me, the undersigned Notary Public in and for said country and state, personally appeared Z *, Nora Taylor Burkern , and acknowledged his/her signature to the above Project Completdon Affi , "i « � the 8th day ,Aat ust 01 9,�Ct." > Notary SN 9/21 2021ure M Commission Expires 1"i Al" Taylor A. Bur e 111111 �' Printed Name County of Residence Tzke If the Contractor is a corporation, the following certificate will be executed. I, Roger W. Marshall certify that I am3A&4te &? oration executing this release; that gFrank a rs all who signed this release on behalf of the contractor was then re s � dent of said Corporation; that said release was duly signed for and on behalf of said or n by Authori f ' Bove ling body, and is within the scope of corporate powers: loo ^� 3kr C ' Srgnatvre-- V e resident Corporate Seal Roger W. Marshall Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL table for f pprovat and we recommend to the Board of Public Works that it be ordained so. Thipro� t is acceptable tl p Date: Constructio 'der Gary A. Gilot, President Therese J. BOARD OF PUBLIC WORKS APPROVAL Genevieve E. Miller, Member Laura O'Sullivan, Member Date: Eliabet A. Mara ik, ernber Linda Martin, Clerk.