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Ir <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Installation of Electronic Vehicle Supply Equipment <br />PROJECT NO 121-011 FINAL COST $64,452.24 <br />CONTRACT SIGNED 7/26/2022 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Installation of EV charges are the DTSE parking garages, Century Center, and Zoo <br />WITNESSETH: <br />The work under the above contract between the Carty of South Bend and the undersigned contractor having been <br />completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever <br />arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and <br />Standards of the City of South Bend which were a part of the above Contract. <br />Executed this f 5th <br />day of February- _, 202 3 <br />Koontz -Wagner Services, LLC <br />_ <br />Mike Dannert <br />°°`•� <br />�'��"'"' "' <br />Company Dame <br />1?an Y <br />Signature <br />3801 Voorde Dr. Suite B <br />Mike Dennert <br />State o <br />Notary Pu=Counly <br />Company Address <br />p �' <br />Printed Name <br />St Josep <br />South Bend, LN 46628 <br />My Commission E <br />City, State, zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country <br />and state, personally appeared <br />"c' sVe fern <br />, and acknowledged his/her signature to the above Project Completion Affidavit on <br />the S day of VC 202 —6 <br />.� c <br />Notary SignataYe My Commission Expires <br />._' V� e <br />Printed Name County of Resident¢ �] <br />If the Contractor 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 goveming body, and is within the scope of corporate powers: <br />Secretary's Sigulture <br />Printed Name <br />Corporate Seal <br />DEPAWrMENT 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: 2/27/2023 <br />Con uction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />M <br />Joseph R. Molnar, Vice President <br />Jordan V. Gathers, Member <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: March 14, 2023 <br />