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CITY OF SOUTH BEND, INDIANA�" r , <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT, <br />PROJECT NAME Farmington 14A Lift Station Rehabilitation <br />PROJECT NO. 117-027 FINAL $337,452.56 <br />COST <br />CONTRACT 11/28/2017 MAINTENANCE AGREEMENT 09/30/2021 <br />SIGNED ENDS <br />PROJECT Rehabilitation existing Farmington 14A Sanitary Sewer Pump Station <br />DESCRIPTION <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 />1t'h _ y September 19 <br />Executed this a of p 20 ,mm <br />Signal re <br />John Boettcher <br />Print'. ame <br />John Boettcher Sewer & Excavating, Inc. <br />Company Name <br />3305 North Home Street <br />...... <br />Company Address <br />Mishawaka, Indiana 46545 <br />City/State/Zip <br />WITNESS <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />John W. Boettcher and acknowledged his/her signature to the above Pro'ec M NotaI'Mry Public, <br />LEONARD <br />�. ______. W..... , <br />�� <br />September on the 16th day of P.... 201„w9 <br />� w"" �' °" „ N ublic, State of Indiana <br />�r� Commission R 684989 <br />'eA` <br />My Commission Expires <br />Notary Signature My Commission Expires May 9, 1plis'si^ "ss oly 09. 2024 nowl <br />Elicia A. Leonard <br />_................................... ............................ .._ <br />Printed Name County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />I <br />John W. Boettcher certify that I am Secretary of the Corporation executing this release; that <br />John W Boettcher <br />m� who signed this release on behalf of the contractor was then <br />President mmmmmm of said Corporation; that said release was duly signed for and on behalf of <br />sa¢ 1 Corporation of its governing body, and is within the scope of corporate powers: <br />ecre a °s Signature Corporate Seal <br />John Boettcher <br />T'riAt"dd 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 />as ro 1" Date: D 9- 23- Zo/9 <br />onstruction Manager <br />B ARD Off" PUBIA ' C�'I�.S APPROVAL Date: q�� <br />, „4sra'rllan, Me <br />mberGar A. PresiGenevieve E. Miller, Member <br />`y <br />C 1& <br />Eliza beffA. Maradik, Member T erese , DorCK Member nda M. Martin, ;lerk <br />