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lPrw. tF' 6f9 �.f.r:. <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS��� <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME _L2!a�retttBuilding Drain Replacement <br />PROJECT NO 119-042 FINAL COST $57,872.60 <br />CONTRACT SIGNED 5/14/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Replace the east and west interior roof drains1pipingi in the Lafayette Building <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend which were a part of the above Contract. <br />Executed this 1114 day of —a <br />i4l_wwwwwww 201 G% Niez odski Plumbing, Inc. <br />„m Company Name <br />Signature 232 North Mayflower Road <br />IF' Company Address <br />Printed Name South Bend, IN 46619 <br />City, State, Zjo <br />WITNESSESS: ASHLAN MACKENNA SMITH <br />Befog me, the undersigned Notary Public in and for said country and state, personalElMyCornmission <br />pe seai <br />�, E 41ua _State of Indiana <br />and acknowledged his/her signature to the above Project Coion 9fff 1,VdF';t��?a and y <br />CC a Expires May 20, 2025 <br />they ........,201�. <br />re���� �' -...• `� My Commission Expires r� <br />Printed <br />� °a t .. <br />d Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed, 4 <br />I, �%� '� .mm_r,� mmmmmmmmm certify that I am Secretary of the Corporation executing this release; that <br />who signed this release on behalf of the contractor was then <br />w .... of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation b Author'ry of its governing body, and is within the scope of corporate powers: <br />Secretary s Si,gi ire <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptably fay final approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Construct "r awn _. <br />�T�eT <br />BOARD OF PUBLIC WORKS APPROVAL Date; ) 7 d 0 ( % <br />/�Nnt) U) <br />Gary A. Gilot, President <br />Therese J. Vorau, sober m <br />Genevieve E. Miller, Member Eliza, ent A. Maradik, Member <br />Laura L. O'Sullivan, Member <br />M. Martin, Clerk <br />