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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS" <br />PROJECT COMPLETION AFFIDAVIT' <br />PROJECT NAME Erskine Clubhouse Renovation <br />st <br />PROJECT NO, 116-108 FINAL COST <br />CONTRACT SIGNED Au 28 l , t o . ooITITIT mmmmmm <br />gu , 2019 MAINTENANCE ,GkEEM 1'S"1"ENDS <br />PROJECT DESCRIPTION Renovation of clubhouse at Erskine Golf Course. <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />Executed this 12th day of A„ ,,q , 20 19 <br />Sig6ture <br />Bill Favors <br />Printed Name <br />Ziolkowski Construction <br />Company Name <br />4050 Ralph Jones Drive <br />Company Address <br />South Bend, IN 46628 <br />�................... _......._ .............. <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally <br />appeared_ Bill Favors , and acknowledged his/her signature to the above Project Completion <br />Affidavit on the 12th day of August , 201........... <br />�"� "" LYNNDVINING <br />No Si M Commission Expires seal <br />' y p ' " „_67�rYkNI( - Sfalerl Indiana <br />L nn D. Vining Elkhart County <br />- •••— y My Commission Expires Mar 6, 2025 <br />Printed Name Count of Residence 1;1k <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, , Rq,b,�zr!..A,...R.aNh.................................................... , certify that I am Secretary of the Corporation executing this release; that <br />Bill Fayorsw_ who signed this release on behalf of the contractor was then <br />President CFO of said Corporation; that said release was duly signed for and on behalf of said <br />oa akio by Author'of its governing body, and is within the scope of corporate powers: <br />....... . <br />r <br />Secretary's Signature Corporate Seal <br />Robert A. Bash <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be <br />ordained so. <br />Date: l <br />Constru ti anager - <br />BOARD OF PUBLIC W III S APPROVAL Date: <br />Ga1y A. G l it, President Genevieve E. Miller, Member Elizabeth A. Maradik, Member <br />—/. <br />Laura L. O'Sullivan, Member <br />