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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT -.-- <br />PROJECT NAME Grandview Ave and RR Qwick Kurb Installation <br />PROJECT NO 117-114 FINAL COST $17.785.00 <br />CONTRACT SIGNED December 13, 2022 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION -Install Qwick Kurb, provided by the City, on Grandview Ave at the railroad Mdi <br />WITNESSETH: crossing. <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend which were a part of the above Contract. <br />Execu d this 7th d y f April gft 2023 <br />Signature <br />Justin Butler, Vice President <br />Printed Name <br />Selge Construction Co., Inc. <br />Company Name <br />2833 South 11 th Street <br />Company Address <br />Niles, MI 49120 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Justin Butler , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 7th dl_of April it Rak 0023. <br />� s y <br />~ otary Signature VMy Commission Expires 10/27/2027 <br />Allison Swinehart <br />Printed Name <br />County of Residence <br />Berrien <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Allison Swinehart certify that I am Secretary of the Corporation executing <br />Justln Butler who signed this release on behalf of the contract <br />Vice President of said Corporation; that said release was duly signed for ar <br />jC pore#ion by Auth". of its governin body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Allison Swinehart <br />Printed Name <br />`y��Ca� [•4 J V'pl���� r�i <br />a <br />COuNl YRELIC`• y <br />its lel"eA-g <br />was themb'B127� 2U7 <br />be or 1p <br />Id <br />Corporate Seal <br />DEPARTMENT 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: <br />Construction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />V'a( <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Joseph R. Molnar, Vice President <br />�181 <br />Jordan V. Gathers, Member <br />611 X. <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: Anril25.2023 <br />