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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS;a.` <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME ,Lafayette Building Cleanout <br />PROJECT NO 119-098 FINAL COST $13,550.00 <br />CONTRACT SIGNED 11/12/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Clean up and remove debris piles and furniture at the Lafayette Building, <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 />Ex�pctl this. 28th� d of _. January 20 200 HomeWorks Construction Inc. <br />Company Name <br />Signa ur 1511 Pulaski St. <br />Jeffrey Smallwood Company Address <br />Printed Name <br />South Bend, IN 46613 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Jeffrey Smallwood , and acknowledged his/her signature to the above Project Completion Affidavit on <br />,the 2gth day of- 20 20_. <br />Notary Signature My Commission Expires z0z 2— <br />Denise M Long <br />Printed Name County of Residence St. Joseph <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, JoseRI Colvin certify that I am Secretary of the Corporation executing this release; that <br />ffrev SmalWoodl who signed this release on behalf of the 0 (Acontractor was he <br />of said Corporation; that said rele sNotary Public. n ao DWsa <br />rp ation by tho it f 1 governing body, and is within the scope of core rate power Seal <br />State of Indiana <br />Secr ary"s Signs ure St Joseph County,dose h Colvin <br />My Commission Expires Sep 14t;eal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for fin 1 approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: 30. to <br />Construction der <br />PUBLIC WORKS APPROVAL Date: � f <br />BOARD OF, � ._.® <br />�,��. �� " 1. . —d a <br />Gary A. Offol, President J rd. n V, Gathers, tvfe ber Elizabeth A, Maradik, Member <br />erese J. Y orb' , Member seph R. <br />M. Martin, <br />