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ai;�ii3dt "n <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS ",,q' <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Fire Stations 3 & 6 Abatement Quote <br />PROJECT NO 118-047A FINAL COST $7,900.00 <br />CONTRACT SIGNED 1/28/2020 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Asbestos abatement on existing floors at Fire Stations 3 & 6. <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 i Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by suc ontract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of S ith Bend wh ch wer part of the above Contract. <br />E CLI this ay of 20S C ..................... Clean Air Environmental Services, I'nc, <br />Company Name <br />Signature 64433 State Road 23 <br />Company Address <br />Printed Name rth Liberty, IN 46554 <br />atiiron' LENA K IIVPSHECt <br />,w w r ;, r";,M NOMV Public. State of I�r 14 <br />w 0 mtiart COWRY <br />WITNESSESS:fu„°" d C�pp��m��,„rtrrs tt 702883 <br />f re e, the redesigned Notary Publlyt ,a11r sal,acr�Ar&d t 60, <br />r cAAand acknowledg "', I "k atgnaturewV re <br />the day of 201 <br />Notary Signature / My Commission Expires <br />Printed Name County of Residence <br />State, Zip <br />sally appeared <br />Completion Affidavit on <br />-7[1:j J aoa-� <br />If the Contractor is a corporation, the following certificate will be executed. �k1 <br />I, 446A <br />✓%N4 certify <br />that <br />o s gn d thist a easeary of hon behalf oo <br />who t <br />of said <br />on; that said <br />ease was dul <br />and on <br />r orati nby Au My of its governing body, and is within scope of of pore a powe t c C A` calf taf saw <br />Co � .7 �- <br />9#1--t <br />etary`s Ignatu F�*Seal <br />**.• <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This projects aoce table fo fi I approval and we recommend to the Board of Public Works that it be ordained so. <br />I Date: <br />Construction timer <br />.m <br />WORKS Date: w„® . <br />�� �W R OVAL <br />°ary A. Gilrst;° resident Jet'rl :n V. Gathers, M6hiber E tzabeth A. Marddik, Member <br />Ther se J. D (au, Member ° °" JOs ph R. Molnar, Member """ Linda M. Martin, Clerk <br />