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JANEE M TOWNER <br />NOTARY PUBLIC <br />SEAL <br />ELKHART COtiM STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, 2026 <br />COMMISSION NO.710399 <br />PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA/�. <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT1H5 <br />-Speed Hump Installation Bid <br />120-043 FINAL COST $210,400.00 <br />8/25/2020 MAINTENANCE AGREEMENT ENDS <br />Installation of s eed humps in various neighborhoods throughout South Bend. <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 t s L <br />� day of 2Q,i a Premium Concrete Service, Inc. <br />Company Name <br />Signature 712 Richmond Street <br />ffl ,A k 4C A KE q Company Address <br />Printed Name Elkhart, IN 46516 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />NA&`(EAI~Ed _, and acknowledged his/her signature to the above Project Completion Affidavit on <br />the C� day of LJC-f013t R , 20A 10 <br />N tary Signature My Commission Expires i) <br />br1% !2 <br />Printed Name County of Residence �[��jq 12T <br />If theContractoris a corporation, the following certificate will be executed. <br />I, MAN <br />Y, I Y, EA certify that I am Secretary of the Corporation executing this release; that <br />x EA 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 />Corporation Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature Corporate Seal <br />MA x���:� <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 ordained so. <br />Date: 11 /02/2020 <br />Construct' n Manager <br />November 10, 2020 <br />BOARD OF PUBLIC WORKS <br />Qt— <br />Gary A. Gilot, President n ' <br />Elizabeth A. Maradik, Member <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Therese J. Doran, Member <br />Jordan V. Gathers, Member <br />ATTEST: <br />�ntda c�PTaz;,, <br />Joseph R. Molnar, Member <br />Linda M. Martin, Clerk <br />