Change Order No 2 & PCA - 2022 Contractor Paving, Round II Proj No. 122-032 - Rieth-Riley Construction Co., Inc.

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�1777i &F CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS ?��, PROJECT COMPLETION AFFIDAVIT Ff5 PROJECT NAME 2022 Contractor Paving Round 2 PROJECT NO 122-032 FINAL COST $2,051,402.83 CONTRACT SIGNED 7/26/2022 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Provide and install HMA surface pavement, pavement striping and markings, and ADA curb ramps on several streets located in South Bend, Indiana. 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. ExecVtgd this Z day of 20 2 5 Rieth-Riley Construction Co., Inc. % Company Name Signature 25200 State Road 23 2" e4l Company Address Printed Name l L��o Cam, South Bend, IN 46614 City, State, Zip WITNESSES: %B fore me, the undersigned Notary Public in and for said country and state, personally appeared Abe I 6106trado , and acknowledged his/her signature to the above Project Completion Affidavit on the 7.2- day of N61lrCV1 202-�)_. Notary Signature My Commission Expires Q har �312,6.60 I \aC,I(1 a-e ( CZQ ran 2r K� Printed Name County of Residence GYirsh�r If the Contractor is a corporation, the following certificate will be executed. I, S 2 E , certify that I am Secretary of the Corporation executing this release; that �_ (,.b-an 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 Corp , ration by t ority of its governing body, and is within the scope of corporate powers: . RACHAEL M CZARNECKI Uetary's Signature `o�!:"•Y p�®� Notary Public, State of Indiana 5:; • n= Marshall County Corporate Seal $EAL� # Commission Number NP0744094 H %.,zzyo •�`�: My Commission of Printed Name ''��n,im�"`� October03,2030 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. &A ,L_Z�w- Date: 3/23/2023 Coneyuction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Joseph R. Molnar, Vice President Jordan V. Gathers, Member (t„ /X Attest: Theresa M. Heffner. Clerk Date: April 11, 2023