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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME WWTP Raw Sewa Pum No. 2 Rehabilitation <br />PROJECT NO. 118-020 FINAL COST $380,833.00 <br />CONTRACT 12/20/2018 MAINTENANCE AGREEMENT ENDS 11/19/2022 <br />SIGNED <br />PROJECT Raw Sewage Pump No. 2 rehabilitate, new impeller, replacement parts <br />DESCRIPTION <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />hxccute't Ills day of IVIA,VCk,20 �......._ <br />Cornerstone Stewards, Inc. <br />Signature Company Name <br />Yl l t, ' Y 1 G�� ►/� S �(� 5720 Huguenard Road <br />Printed Name Company Address <br />Fort Wayne, Indiana 46818 <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />'Ux,o, a�A R Masz and acknowledged his/her signature to the above Project Completion Affidavit on <br />th t't Iay of y ..._ 20X 40 <br />-,Not4 Signature ` My Commission Expires I Z ZD 2( <br />., 1 %C <br />Printed Name County of Residence A � ��►� <br />If the Contractor is �1 eoa aor ration, the following certificate will be executed. <br />1, W itsSQ V „ certify that I am Secretary of the Corporation executing this release; that <br />IT. „ fir,>„ ITIT who signed this release on behalf of the contractor was then <br />y'k, of said Corporation; that said release was duly signed for and on behalf of said <br />Corpoaatio i t, y Authority 1'ts governing body, and is within the scope of corporate poWcm <br />ecact�ary's Sagnatara <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be <br />ordained so. <br />° n Date: 03, 23-ZcZo <br />ConstructioManager <br />BOARD OF PUBLIC WORKS APPROVAL <br />Gary A. Gilot, President <br />Joseph R. Molnar, Member <br />Jordan Gathers, Member <br />Date: <br />Elizabeth A. qaradik,, Member <br />Therese J. Dorau Member "° Linda M. Martin, <br />