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i� �ytl4 tl BA i7,1.yh <br />CITY OF SOUTH BEND, INDIANA� <br />BOARD OF PUBLIC WORKS � <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Liberty Tower Improvements DivA- Upper Level Roof Work <br />PROJECT NO 118-086R FINAL COST $262,140.50 <br />CONTRACT SIGNED 2/12/2019 MAINTENANCE AGREEMENT ENDS <br />Provide and install Exterior Improvements as outlined in three separate Divisions; Division A: <br />PROJECT DESCRIPTION UDDer Level Roof Work. <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 + erg a part of the above Contract.. <br />I,this Ada Slatile Roofing and Sheet Metal Co., Inc <br />Company Name <br />re e — 1703 South Ironwood Dr„ <br />C Company Address <br />Name South Bend, IN 46613 <br />City, State, Zip <br />e���dt�nrrr�� <br />WITNESSESS:r`+ P� <br />afore a the undersigned Notary Public in and for said c �frd st�� p*onally appeared <br />and acknowledged his/her signature t e above.P� Completion Affidavit on <br />day of 2013— <br />SEAL <br />L;09 <br />ig ature My Co ion Expires <br />Printed Name I „M <br />County of Re fden kofosieph <br />If thg Contractor is a corporation, the following certificate will be executed. <br />I _ldg L—oNf ug { 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 />I" of said Corporation; that said release was duly signed for and on behalf of said <br />rp ration by ority of its governing body, and is within the scope of corporate powers: <br />re <br />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for, al: approval and we recommend to the Board of Public Works that it be ordained so. <br />���� w \ Date: <br />Construe " rr na,ger <br />BOA 13 OF PUBLIC WORKS APPROVAL Dater mod' <br />.. �",. <br />Gary A. Gilot President r tmber Elizabeth A. Maradik, Member <br />.......... <br />etas M <br />e J. rau, Merhber µ ra O Sullivan, Member � a M. Martin, Clerk <br />