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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME <br />PROJECT NO FINAL COST $0.00 <br />A G R E E M E N T S I G N E D M A I N T E N A N C E A G R E E M E N T E N D S <br />PROJECT DESCRIPTION UWf <br />WITNESSETH: <br />The work under the above agreement between the City of South Bend and the undersigned owner having been completed, <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under <br />or by such agreement, and that the owner performed the work within the scope of the Specifications and Standards of the <br />City of South Bend which were a part of the above agreement. <br />E x e c u t ^ t h i s I S d a y o f . S O i J f <br />a . c o m p a n y N a m e <br />Bcut^ this <br />signature <br />\ I C o m p a n y A d d r e s sA V-0C':?Y O <br />Printed Name SnuU, tHA. la <br />City, State. Zip <br />WITNESSES: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />and acknowledged his/her signature to the above Project Completion Affidavit on <br />t h e J I S d a y o f . . 2 0 ^ \ <br />My Commission Expires f2.j n "^^7^ <br />\ I 7 ) I <br />( H M a r r i e C o u n t y o f R e s i d e n c ePrinter <br />If the owner is a corporation, the following certificate will be executed. <br />I, , certify that I am Secretary of the Corporation executing this release: that <br />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 by Authority of its governing body, and is within the scope of corporate powers: <br />Gregory John Whmier <br />S e c r e t a r y ' s S i g n a t u r e C N o t a r y P u W i c S e a i s t a t e o i I n d i a n a > <br />^ L a P o f t e C o u n t y / o o r p o r a i e b e a i <br />Commission Number NP0724146 <br />My Commission Expires 12/17/2027 <br />Printed Name <br />D E P A R T M E N T O F P U B L I C W O R K S A P P R O V A L <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Construction Manager <br />B O A R D O F P U B L I C W O R K S A P P R O V A L D a t e : <br />Elizabeth A. Maradik. President Jordan V. Gathers. Member Gary A. Gilot. Member <br />Murray L. Miller, Member Joseph R. Molnar, Member Anne Fuchs, Clerk <br />March 8, 2022