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N <br />CD <br />(d N LO <br />v co n <br />rn <br />o d CD' <br />a (11 E <br />a .X 2, W w <br />.50 <br />~ z v 5 ff <br />T o <br />CITY OF SOUTH BEND, INDIANAVIA <br />BOARD OF PUBLIC WORKS , <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Code Enforcement Door <br />PROJECT NO. N/A �.�_. F.... ...._..__ . .m_ ......... <br />INAL COST _$3,148 <br />CONTRACT SIGNED 6/25/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTIO <br />N Installation of door in Code Enforcement office <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 the r 16th day of August 20..W.19 <br />9 . <br />Signature <br />Eric Brown <br />Printed Name <br />Brown & Brown General <br />Contractors, Inc. <br />Company Name <br />_ <br />a124.....5.. Elkhart 5t...........�_ _�....... <br />Company Address <br />Wakarusa, IN 46573 <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Eric Brown , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the _ day of —......._A 201 9 <br />Notary Signature _ My Commission Expires 4/3/2025 <br />Todd A. Marek <br />Printed Name <br />County of Residence Marshall Co., IN <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Hannah M. Aitken certify that I am Secretary of the Corporation executing this release; that <br />Eric Brown who signed this release on behalf of the contractor was then <br />President of said Corporation; that said release was duly signed for and on behalf of said <br />C orp ration by Authority of its governing body, and is within the scope of corporate powers: <br />_... . <br />Secretary's Signature Corporate Seal <br />Hannah M. Aitken <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 />all QQ <br />Date.: G - Z 4 1 ch <br />Cortstrtrcti n anager �. <br />BOARD OF <br />L. O'Sul <br />APPROVAL <br />David P. Relos, Member <br />Date: <br />c <br />ElizabethA. Mar•adi.k, Member <br />!r/w� <br />