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CITY OF SOUTH BEND, INDIANA um, <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT a" <br />PROJECT NAME Bendix Theater Flooring <br />PROJECT NO 119-106 FINAL COST $72 642.00 <br />CONTRACT SIGNED 12/10/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Remove existinq and install new flooring in Bendix Theater <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 this day of 20" " Carpet Service Outlet, Inc. <br />Company Name <br />Signature 1514 Mishawaka Ave,: <br />Printed Name <br />S <br />MOLLY A ASHERMAN <br />Notary Public Seal. <br />St Joseph County - State of ln4ana <br />WITNESSES& CrmMossion N,umber NP07t7fl35 <br />My prr Miss a Ex Ire J ra g 2 <br />A3 fore tt a undersigned Notary urtt nd sttE <br />" and acknowNedge NoslNaer signa acre e a ve <br />th ay of 201�0 <br />Nota gnature My Commission Expires <br />MoLL,1/KWEWAN <br />Printed Name County of Residence <br />Company Address <br />South Bend, IN 46615 <br />City, State, Zip <br />personally appeared <br />Project Completion Affidavit on <br />0 ani <br />If the Contractor is a corporation, the following certificate will be executed, <br />N„ W certify that I am Secretary of the Corporation executing this release; that <br />'v'( 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 />Corporati n by Autf rNly of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Corporate Seal <br />h_NJ <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable f N I approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: 3 <br />Construe ' nager <br />BOARD OF PUBLIC WORKS APPROVAL Date* a-�� <br />Gary A. GNlot, President Jordan Gathers wabt A. aradNk, Member <br />Therese J. Dorau, Member Joseph Molnar <br />M. Martin, Clerk <br />