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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Berlin Place BP#2: M.E.P. <br />—111-1-- ........... <br />PROJECT NO. 117-048 W.FINALCOST $3,818,000.00 <br />CONTRACT SIGNED June 13, 2017 MAINTENANCE AGREEMENT ENDS <br />J ..... . ..... <br />PROJECT DESCRIPTIn <br />ON Installation of all Mechanical, Electrical and Plumbi�&., <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 />11' uted this 421 Im day of A...........V(.,VST- 20 <br />, <br />N H % CBS Serviccs..L1,.(,' <br />x,'% ompany Name <br />Si nature C <br />9 <br />401 E, Colfax Ave. #24 <br />Printed Name :=Conipany Address <br />-AL <br />4. 64 South Bend, In, 46617 <br />City/State/Zip <br />WITNESSES <br />"n', said cotintry and state, personally <br />Before i e d ersigned Notary Public �A,,`d <br />appeared,_ and acknowledged his%er signature to the above Project Completion <br />day of � 201 <br />ta Li My Commission Expires <br />rin.. 11 County of Residence 6a �14 <br />If the Contractor is a corporation, the following certificate will be executed. <br />L - — -------- ............... 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 />. ...... -- ------ of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Printed Name <br />Corporate Seal <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. 0 <br />Date: <br />Constrlic' , . anage . r <br />BOA" OF PUBLICWO <br />f A . 111I{ APPROVAL <br />A. Giirit, <br />,i Prc4 ent Genevieve E. Miller, Member <br />v <br />Date <br />q1 <br />4� Oi7ab�th A. Maradik,Mem'be.—r <br />a-ItIc, - <br />L. O'SulTivafi, Member rese J. 0brati, Mcniber ",--thda M. Martin, <br />