PCA - Morris Performing Arts Center - Main Level Slab Rpl. Proj No. 121-029A - Larson Danielson Const. Co., Inc.

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CITY OF SOUTH BEND, INDIANA <_ BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT - PROJECT NAME Morris Performing Arts Center - Main Level Slab Replacement PROJECT NO 121-029A FINAL COST $ 975 535.70 CONTRACT SIGNED 12/30/2021 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION -Replacement of floor slab and other improvements on the main level of the Morris 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 1st day of February , 2023 .�a•ti Signature Darin Meyer Printed Name WITNESSESS: Before me, the undersigned Notary Public in Darin Meyer , and acknowledged the 1 St _ day of February 2p 23 a. Ha ii�—Jt Not Solature J16ftnifer A Medley Printed Name Larson -Danielson Construction Co., Inc. Company Name 302 Tyler Street Company Address La Porte, IN 46350 City, State, Zip and for said country and state, personally appeared his/her signature to the above Project Completion Affidavit on My Commission Expires County of Residence JENNIFERAMEDLU My Commission Expires Au 8� 0 August 1, 2030 :yk '9 missxm NUMM NP06M434 .°F La Porle County La If the Contractor is a corporation, the following certificate will be executed. l Jeffrey R Jensen certify that I am Secretary of the Corporation executing this release; that Darin Meyer who signed this release on behalf of the contractor was then Sr, Project Manager/Concrete Manager of said Corporation; that said release was duly signed for and on behalf of said Crpo� . on by harity of its governing body, and is within the scope of corporate powers: 1 S 's Sign ure y Corporate Sea' Je rey R Jensen.,, LARSON DANIELSON Printed Name Ss^�/� CONSTRUCTION CO., INC. M,oi DEPARTMENT OF PUBLIC W This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: 02/17/2023 Constructio Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS 10�4 11�(-zrn Elizabeth A. Maradik, President Gary A. Gilot, Member Joseph R. Molnar, Vice President Jordan V. Gathers, Member '/ Y Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: February 28, 2023