Change Order No 1 & PCA - Privet Lane Culvert Replacement Proj No. 118-013B - HRP Construction, Inc.

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CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Privet Lane Culvert Replacement Project PROJECT NO 118-013B FINAL COST $260,587.78 CONTRACT SIGNED 12/19/2019 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Realace and upgrade the culvert on Privet Lane. WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a art of the above Contract. Exe d thi 6 ust 281( 2020 HRP Construction, Inc. Company Name Signature 5777 Cleveland Road, P.O. Box 266 MatthewD . Cain Company Address Printed Name South Bend, IN 46624-0266 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Matthew D . C a in and acknowledged his/her signature to the above Project Completion Affidavit on the 19 thday of August >2;04 2020 Mw�w„ r" �� CYNTHIA L. VANHESTE Notary Public, State of Indiana M w"L* w : St. Joseph County *: y Commission Number 681273 `•; , ltilota o igrature My Commissi d �X .y Co Expires Cvnthia L. Vanheste WIN Printed Name County of Residence St. Joseph If the Contractor is a corporation, the following certificate will be executed. I, KI A n r K n a n i 1� certify that I am Secretary of the Corporation executing this release; that Matthew D . Cain who signed this release on behalf of the contractor was then Presidpmt of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Secretary's Si ature Nangy Knapik Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptabl f final approval and we recommend to the Board of Public Works that it be ordained so. Date: 8 Z S' z o ConstrutZT anager BOARD OF PUBLIC WORKS APPROVAL Date: September 22, 2020 BOARD OF PUBLIC WORKS Gary A. Gilot, President n Elizabeth A. Maradik, Member �'Y L Joseph R. Molnar, Member Therese J. Doran, Member Jordan V. Gathers, Member AITEST: Er,,:aa Linda M. Martin. Clerk