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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2019 Contractor Pavin <br />PROJECT NO 119-062 FINAL COST $4421456.77 <br />CONTRACT SIGNED 7/23/2019 MAINTENANCE AGREEMENT ENDS /+`" OX., <br />PROJECT DESCRIPTION Perform asphalt milling and surface replacement, including striping, within the City South Bend. <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 />Executed thi of u n&+-T,ryF 20 A 0 RiNamelConstruction Co., Inc. <br />Company <br />Signat 25200 State Road 23 <br />t1Gl �C1011 ,� Company Address <br />Printed Name South Bend, IN 46614 <br />City, State, Zip <br />WITNESSES: <br />afore me, the n+ ersigne <br />Notary Public in and for said country and state, personally appeared <br />r <br />d acknowledged his/her signature to the above Project Completion Affidavit on <br />the 0- day o <br />20 4 <br />Notary Signature <br />My Commission Expires 0/0) ;- /a a <br />Printed Name <br />�e <br />County of Residence <br />If the Cotract'or l�rp tion„ the following certificate will be x ted, <br />I, w r� <br />certify that I am eoretary of the Corporation executing this release; that <br />'C" <br />M I 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 c a s: <br />A � <br />SUE ANNE CIRA <br />Seal <br />Secretary's S uqe Notary Public • State of Indiana Corporate Seal <br />7My <br />St Joseph County <br />Printed Name <br />Commission Expires Oct 22, 2022 <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project %cceptahle for" in I approval and we recommend to the Board of Public Works that it be ordained so. <br />_ <br />. Date: <br />Constr'uc ioi ager <br />, <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Lille <br />Gary A. Gil t„ President <br />Jo Gathers, Manta er Eliza e'th A, Maradik, Member <br />Therese J. Dorau, Member <br />ph Molnar, Member "'"", nda M. Martin, Clerk <br />