PCA - Water Works North Pumping Station Well Replacement Proj No. 117-031R - Peerless Midwest, Inc.

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CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Water Works North Pumping Station Well Replacement PROJECT NO 117-031 R FINAL COST $547,558.72 CONTRACT SIGNED 2/26/2019 MAINTENANCE AGREEMENT ENDS Construction of a new Well No.1 at the City's North Station treatment plant. Improvements PROJECT DESCRIPTION include construction of a new well, well head, approximately 100 feet of 10-inch water main. 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. Exec t this 7th day of January 2040 Peerless Midwest, Inc. Company Name S° 11alure " 55860 Russell Industrial Parkwa James R. Williams Company Address Printed Name Mishawaka, IN 46545 City, State, Zip WITNESSESS; B fore th l�71efsigped Notary Public in and for said country and state, • f t amm'and acknowledged his/her signature to the above F the 7th day of +" „ 201t1 Notary PublicJanua- michi gn , y C Cass count l M Commission Expires Jul 5µ f Nota Signature My Commission Expires Acting in the County f . Robin L. Kealy Printed Name County of Residence Cass If the Contractor is a cor oration, the following certificate will be executed. Michael J • Williams certify that I am Secretary of the Corporation executing this release; that James R. Williams who signed this release on behalf of the contractor was then e er l Manager of said Corporation; that said release was duly signed for and on behalf of said Corporation by uthority, s governing body, and is within the scope of corporate powers: Secretarv's Si nature Michael J. Williams Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable fo fi I approval and we recommend to the Board of Public Works that it be ordained so. Date Constructio ager �t k BOARD OF �'+ M Gary A. G081, President APPROVAL Date: '� $ Elrzateth A. Maradik, Member Therese J. 0orau, Member , °f Me — -/Onda M. Martin, Cle