PCA - COSB Wayfinding Signage Program - Phase II Proj No. 120-020 - Geograph Industries, Inc.

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CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME COSB Wayfinding Signage Program, Phase 2 (Base & Alt. 1 & 3) PROJECT NO 120-020 FINAL COST $146,411.00 CONTRACT SIGNED 1/26/2021 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Fabrication and installation of wayfinding signage including concrete footings, foundations and sidewalk repair within the City of South Bend, IN. 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 part of the above Contract. Executed this ________ day of _________________, 202__________.Geograph Industries, Inc. Company Name Signature 475 Industrial Drive Company Address Printed Name Harrison, OH 45030 City, State, Zip WITNESSES: Before me, the undersigned Notary Public in and for said country and state, personally appeared _____________________, and acknowledged his/her signature to the above Project Completion Affidavit on the ________ day of _____________, 202______. Notary Signature My Commission Expires Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. I, ____________________________________, certify that I am Secretary of the Corporation executing this release; that ___________________________________________ who signed this release on behalf of the contractor was then __________________________________ 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: Corporate SealSecretary's Signature Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: Construction Manager BOARD OF PUBLIC WORKS APPROVAL Date: ________________________ Elizabeth A. Maradik, President Jordan V. Gathers, Member Joseph R. Molnar, Member Gary A. Gilot, Member Murray L. Miller, Member Clerk 10/29/2021 November 9, 2021