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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2019 Curb & Sidewalk Div.D2 <br />PROJECT NO 119-004 FINAL COST $39,108.90 <br />CONTRACT SIGNED 5/28/2019 MAINTENANCE AGREEMENT ENDS <br />Remove and replace concrete sidewalk, concrete curb, ADA compliant curb ramps, and <br />PROJECT DESCRIPTION concrete approaches as a part of the 2019 Curb and Sidewalk Program, <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 were a part of the above Contract. <br />Executed thl day of�1�,y 201 Premium Concrete Services, Inc. <br />Company Name <br />nature 712 Richmond <br />_........ ....... <br />Company Address <br />Printed Name Elkhart, IN 46516 <br />City, State, Zip <br />WITNESSES: <br />Before rne, I'�""IAXl E theUndersigned andNotary acknowl acknowledgedic his/and herh s heror said country sign signature to he and <br />abovestate, personally appeared <br />Pi . <br />da.vit on <br />the day of 1 kVCmlbEfe, , 201�. JANEEMTOWNER <br />NOTARY PUBLIC <br />Nota Signature My Commission Expire yaEAL <br />1�CE f �N EXPIRES FEEPU 1,_b <br />Printed Name County of Residence l <br />ISION N4�,i"1t�;1I <br />I <br />If the Cot tractor is corporation, the following certificate will be executed. <br />certify that I am Secretary of the Corporation executing this release; that <br />XQ C° <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 y Authority of its governing body, and is within the scope of corporate powers: <br />S t ry`s tgnature <br />Corporate Seal <br />M 'A <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This projects acceptable f r I approval and we recommend to the Board of Public Works that it be ordained so. <br />Date; C7 • Z Z • lC) <br />Construe ' Manager . q <br />.. <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />l t o)Lo f / <br />/itl-1 d,,�U- ) — w <br />- UL,W(-- <br />Gary A. Gtlott, resident , Genevii^e E. Miller, M;jb'pf Eliza eth A. Maradik, Member <br />Therese J. Dorau, Member / Xbura O'Sullivan, Me rz' `---dkd'a. M. Martin, Clerk <br />