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l" <br />0 pit <br />CITY OF SOUTH BEND INDIANA ° <br />w' tip: <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />i86 <br />PROJECT NAME Farmington 14A Lift Station rehabilitation <br />PROJECT NO. 117-027 FINAL $337,452.56 <br />COST <br />CONTRACT 11/28/2017 MAINTENANCE AGREEMENT 09/30/2021 <br />SIGNED ENDS <br />PROJECT Rehabilitation existing Farmington 14A Sanitary Sewer Pump Station <br />DESCRIPTION <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />Executed this 16th day of September <br />b <br />AJohn <br />eBoettcher <br />111rinl-ed Name <br />2019 <br />John Boettcher Sewer & Excavating, Inc. <br />Company Name <br />3305 North Home Street <br />_.. ... <br />Company Address <br />Mishawaka, Indiana 46545 <br />City/State/Zip <br />WITNESS <br />Before me, the undersigned Notary Public in and for said country and stat , M <br />John W. Boettcher and acknowledged his/her signature to the above Pro'e' cowl g$;�no alas <br />o..... .._..oat . ._._.... , g g ) State cat Indiana <br />rnm <br />Of <br />y September , 2019 on the 16th day of <br />My Commission Expires <br />Moy 09" 2024 <br />Notary Signature My Commission Expires May 9„ <br />Elicia A. Leonard <br />Printed Name <br />County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, John W. Boettcher certify that I am Secretary of the Corporation executing this release; that <br />John W Boettcher 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 <br />saiu Cor oration,by,7�m ority of its governing body, and is within the scope of corporate powers: <br />Secre a�°y's Signature <br />oh Boettcher Corporate Seal <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: 499,23- ZV19 <br />Construction Manager <br />BOARD OF PUBLIC WORKS APPROVAL <br />Gary A. Gilot, President <br />Date: <br />Genevieve E. Miller, Member <br />Laura O'Sullivan, Member <br />Attest: <br />Elizabeth A. Maradik, Member Therese J. Dorau, Member Linda M. Martin, Clerk <br />