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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJI"CTNAME South Well Field Backwash Line Relocation <br />I I 7-059C FINAL COST $233.590.00 <br />CONTRACT SIGNED 9/13/2022 MAIN'I'ENANCI�'-'AGREI--,M]-"N,r ENDS <br />PROJECT DESCRIPTION Relocation of the backwash line at the South Well Field Treatment Plant. <br />WITNESSETI 1: <br />The work under the above contract between the City 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 pert-onned the work within the scope of Specifications and <br />Standards of the City of'South Bend which were a part of the above Contract. <br />Executed this 9TH <br />Signatur'c <br />Nancy Knapik <br />day nI- December <br />2022 <br />FIRP Construction Inc. <br />Company Name <br />P.O. Box 266 <br />Company Address <br />Printed Name South Bend, IN 46624-0266 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Nancy Knapik and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 9th day of December 2022 <br />Naary Signature My Commission Expires <br />Cynthia L. Vanheste <br />Printed Name <br />County of'Residence <br />CYNTHIA L. VANHESTE <br />04 <br />X Notary Public, state of Indiana <br />0 St. Joseph County <br />"24nmission Number 681273 <br />5 !on Expimes <br />E-,, 4, <br />06, 2024 <br />March <br />T. Josepin <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, Nancy Knapik certify that I am Secretary of the Corporation executing this release; that <br />Nancy Knapik who signed this release on behalf of'the contractor was then <br />Secretary_ of said Corporation; that said release was duly signed for and on behalf ol'said <br />Corporation by Authority o4'its governing body, and is within the scope of corporate powers: <br />Secretary's -.'ignature Corporate Seal <br />Nancy Knapik <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />]'his project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />A� A Date: 3/15/2023 <br />Constiiori Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />IS 1=1 <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Joseph R. Molnar, Vice President <br />Jordan V. Gathers, Member <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: March 28, 2023 <br />