PCA - VPA Restroom Remodeling Proj No. 118-043R - Michiana Contracting, Inc.

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�nra a ep aq v, CITY OF SOUTH BEND, INDIANA, BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT d " PROJECT NAME VPA Restroom Remodeling PROJECT NO 118-043R FINAL COST $529,308.82 CONTRACT SIGNED 1/22/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Renovate 11 VPA Park restroom facilities WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. Execu ed this 27th day ofNovember , 2019 Michiana C ntractin Inc. Company Name Signature 7843 Lilac Rd. PO Box 929 W Company Address Printed Name Plymouth, IN 46563 City, State, Zip WITNESSES& Before me, the undersigned Notary Public in and for said country and state, Scott it atrick and acknowledged his/her signature to the above Pr ect Comp1A fjlp� ltSbfiR the t ay of No c j r 2019 Notary Public - Seal State of Indiana �' Marshall County lit ry Signature My Commission Expires to sio es Mar 27, 2022 Andrea Fisher Printed Name County of Residence Marshall If the Contractor is a corporation, the following certificate will be executed. I Lisa Botto certify that I am Secretary of the Corporation executing this release; that Scott it patri.c' who signed this release on behalf of the contractor was then President of said Corporation; that said release was duly signed for and on behalf of said ratdor by Authority of its governing body, and is within the scope of corporate powers: Secretary's Signature Corporate Seal Lisa Botto Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for, fin approval and we recommend to the Board of Public Works that it be ordained so. Date: Construction ger BOARD OF PUBLIC WORKS APPROVAL Date: l" e, o!0I 4ary—IkAlot, President Genevi ft E, Mifleru ljz4aeWth A. Maradik, Member "Member A ura O'Sull'ivari—Member � ClAda M. Martin,