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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS r "�- <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 315 & 319 W. Jefferson Electrical Re airs <br />PROJECT NO 119-064Q FINAL COST $42,750.00 <br />CONTRACT SIGNED 9/24/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION All electrical work associated with repairinq the 315/319 Jefferson Buildina <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 />Exgcvted this 3&1" day of 7" 2000 Elite Electrical LLC <br />L Company Name <br />Signature 50654 Teall Rd <br />14 j o-v% Pq CMS ^_ Company Address <br />Printed Name Bristol, IN 46507 <br />City, State, Zip <br />WITNESSESS: <br />B fore me, tfife undersigned Notary Public in and for said country and state, personally appeared <br />and acknowledged his/her signature to the above Project Completion Affidavit on <br />the ,. day of 20XQD_ <br />Notary i mature My Commission Expires QT <br />pp <br />Printed ame County of Residence J& <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 />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 poFe <br />BRBah tBSt.J p�h CwSecretary's Signature y CtfiflNjjK Eft jttS <br />C1 l <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project acceptable inal approval and we recommend to the Board of Public Works that it be ordained so. <br />�iG•° Date: 1 • Z (. <br />Constructi dnaKr BOARD ROYAL Date: / .:�:� h.) <br />F P WORKS <br />APPROVAL <br />Gary A. Gilot, President JqTdao V. tathe y er Elizabeth A. Maradik, Member <br />Therese J. 0brau, KTbmber _), -ph Molnar Member L nda M. Martin, <br />