Laserfiche WebLink
CITY OF SOUTH BEND, INDIANA ri , <br />BOARD OF PUBLIC WORKS, <br />PROJECT COMPLETION AFFIDAVIT - <br />PROJECT NAME Hydrant Flow Testing <br />PROJECT NO 119-041R FINAL COST $37,145.00 <br />CONTRACT SIGNED 6/25/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Flow testing and data collection of the Citv fire hvdrants. <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 />E`xeotAt t is �dayof a 201 Shambau h &Son, LP <br />Company Name <br />Signatu 5870 Carbonmill Drive <br />Company Address <br />Printed Name Shambaugh & Son, L.P. South Benda IN 46628 <br />South Bend Fire Protection Div City, State, Zip <br />WITNESSESS: <br />Befare me, t ie undersi ned Notary Public in and for said country and state, personally appeared <br />and acknowledged his/her signature to the above Project <br />the day of 201 Corey A Barnes <br />......._ Notary Publdc Seat State of InOana <br />S1,fosepb County <br />Signature ..,,�, My Commission Expires Mt tuarrtnwrssian q xpkres twttBP4 <br />e <br />V <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I,. 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 />........... <br />of said Corporation; that said release was duly signed for and on behalf of Said <br />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Printed Name <br />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable +or fifixf approval and we recommend to the Board of Public Works that it be ordained so. <br />IN <br />..�. ems. Date: 1. 1 Z- I <br />Consfrlacliot tr <br />tJer <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />A3��_n �Alj�k <br />Gary A. Gilot, President Gen v E. Miller, Me bef°— i a eth A. M radik, Member <br />,P 7 ", <br />JfD6rau, Member 46uh L. O'Sullivan, McFiber f in6a, M. Martin, Clerk <br />