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CITY OF SOUTH BEND, UNDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Morris Performing Arts Center Joint Resealing <br />PROJECT NO 119-050 FINAL COST $13,726.00 <br />CONTRACT SIGNED 5/28/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Reseal exterior uui|uinnio|nm. <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 underor <br />bysuch contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />ofSouth Bend which were apart ofthe above Contract. <br />E 19 Ziolkowski Construction, Inc. <br />-------_ <br />Company Name <br />tignature 4050 Ralph Jones Dr. <br />Company Address <br />Printed Name South Bend, IN 46628 <br />City, State, Zip <br />WITNEaaESS: <br />Before mo, the undersigned Notary Public in and for said country and state, personally appeared <br />Bill 'Pnvnrq , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 11thday of November _209___ <br />Notary Signature <br />syCommission Expires <br />Printed Name County ofResidence <br />If the Contractor is a corporation, the following certificate will boexecuted. <br />|. Robert A. mm*m certify that | am Secretary of the Corporation uxnuuUnQ this release; that <br />who signed this release on behalf ofthe contractor was then <br />oysaid Corporation; that said release was duly signed for and onbehalf nfsaid <br />Corporation byAuthority o/ its governing hvdy, and is within the scope of corporate powers: <br />Secretary's Signature <br />Enhert <br />Printed Name <br />Corporate Seal <br />DEPARTMENT OrPUBLIC WORKS APPROVAL <br />This project is acceptabjef r " al approval and werecommend mthe Board o[Public Works that itbaordained so, <br />