PCA - 315 & 319 W. Jefferson Exterior Renovations (Division B) – Proj No. 119-064 - Ziolkowski Construction, Inc.

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CITY OF SOUTH BEND, INDIANA t �.t BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME 315 & 319 W. Jefferson Exterior Renovations Divi'slon B PROJECT NO 119-064 FINAL COST $64.372.00 CONTRACT SIGNED 8/2712019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Mason repairs at the 315/319 Jefferson Building, 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. Executed this 14th day of larluar r, 2020 2aix Ziolkowski Construction, Inc. �"" w �`.��-•� Company Name Signature 4050 Ralph Jones Drive Bill Eam Company Address Printed Name South Bend, IN, 46628 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Bill Fain rs , and acknowledged his/her signature to the above Project Completion Affidavit on the_ 14th day of lanuar , C� 20 . g� =-StatL w � Notaryubllc Sign My Commission Expires �� P me ianad Name County of Residence Elkhart, 2025 If the Contractor is a corporation, the following certificate will be executed. I, certify that I am Secretary of the Corporation executing this release,, that Bil1.Faxnrs g n who signed this release on behalf of the contractor,' the csirlca �_, of said Corporation; that said release was duly signed for arrd'on behalf of said C rlo fir by u�t r+rut of It o r¢7ingi body, and is within the scope of corporate powers. 1, 1 r- Secretary's Signature) r i Robgrt& Bash Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL �* This project is acceptable for final approval Construction dib ger and we recommend to the Board of Public Works that it be ordaikolks Date: 1. 3 . 2�0 ems.