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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Fire Station #9 <br />••M .. ........ <br />PROJECT NO 116-012 FINAL COST $3 681,702.50 <br />CONTRACT SIGNED 3/13/2018 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Construction of new Fire Station #9 <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 />Execrated this 19th day of v er_ 2019 Ziolkowski Construction, Inc. <br />4�a� - ;,�v2ld <br />Company Name <br />Signature 4050 Ralph Jones Drive <br />— F r , P?xgkdernt & (70 Company Address <br />Printed Name South Bend,, IN, 46628 <br />City, State, Zip <br />WITNESSES& <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />RJI Faye, and acknowledged his/her signature to the above Project C=Public- <br />- <br />the 19th w�@a of V :,#fiber „ 201 9 ININGltate of Indianallotary S��taa��° M Commission Ex firesounty 25y p �11� rrew� Marti, 2025 <br />Printed <br />�nt�ant <br />ed Name County of Residence Elkhart <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, R4.,)bert A. Bils1 certify that I am Secretary of the Corporation executing this release; that <br />Bill Favors who signed this release on behalf of the contractor was then <br />President of said Corporation; that said release was duly signed for and on bqhalfof said <br />Corporatio b Au ority of it ve ning body, and is within the scope of corporate powers: ' <br />", r <br />Secretary's Signature <br />Printed Name AL <br />DEPARTMENT OF PUBLIC WORKS APPROVAL. 0 <br />This ro e tabI fo f 11 approval and we recommend to the Board of Public Works that it be <br />Date: Constructi agr <br />BOARD OF O LIC WORKS APPROVAL Date: z�l l *5 Zc d <br />()4 M1 <br />4a:ry- �4,o V. . &, embe <br />AA�lt, esident���. r Ehzabe6h A. Maradik, Member <br />Therese J. Dorau, Member P', <br />9k <br />.F� � ember •-Yinda M. Martin, Cl <br />