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A "0 <br />CITY OF SOUTH BEND, INDIANA�, <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Vested Interest Buildirx Roof Re air <br />PROJECT NO 119-049 FINAL COST $248,088.10 <br />CONTRACT SIGNED 9/24/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Repair the roof at the Vested Interest Building, 251 East Sample Street, South Bend,, Indiana. <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 />xecufed ftais <br />1 ay of , 20 Midland En ineerin C'om an ,Inc. <br />Company Name <br />... _ <br />Signature 52369 State Road 933 North <br />Company Address <br />Printed Name South Bend„ IN 46637 <br />City, State, Zip <br />WITNESSES: <br />Before me, the undersigned Notary Public in and for said country and states personally appeared <br />1q• f and acknowledged his/der signature to the above Project Compteflon Affidavit on <br />the I O'"*4 day of M A-d 20 <br />F <br />otary Signature My Commission Expires <br />berw ur-, <br />Printed Name County of Residence a <br />If the Contractor is a coorr oration, the following certificate will be executed. <br />1, d °"f AC AF certify that I am Secretary of the Corporation executing this release; that <br />M. • who signed this release on behalf of the contractor was then <br />I �2 of said Corporation; that said release was duly signed for and on behalf of said <br />CorCsr ion b th .ity-o "itgoverning body, and is within the scope of corporate powers: <br />Secretary's Signature Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptabl f f al approval and we recommend to the Board of Public Works that it be ordained so. <br />1 w " Date: J • Zo <br />Constructi ager <br />Gary A. Gilot, President <br />BOARD OF PUBLIC WORKS APPROVAL <br />Jordan Gathers, Member <br />Therese J. Dorau, Member Joseph Molnar, Member <br />Date: C-c� <br />Eris eth A. Mwadik, Member <br />M. Martin, Clerk <br />