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CITY OF SOUTH BEND, INDIANA <br />6 �t <br />BOARD OF PUBLIC WORKS A' <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2022 Contractor Paving Round 1 <br />PROJECT NO 122-008 FINAL COST $1,275,548.42 <br />CONTRACT SIGNED 3/22/2022 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION <br />WITNESSETH: <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 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 />Execu�isiday of April , 20 23 Rieth-Riley Construction Co., Inc. <br />Company Name <br />Signature 25200 State Road 23 <br />Ruben Alvarado, Sales Manager Company Address <br />Printed Name South Bend, IN 46614 <br />City, State, Zip <br />WITNESSES: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Ruben Alvarado and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 19 _ dray of April 12023 <br />Notary Signature My Commission Expires <br />Rachael Czarnecki <br />Printed Name County of Residence <br />10/03/2030 <br />Marshall <br />If the Contractor is a corporation, the following certificate will be executed. <br />Matt Hostetler certify that I am Secretary of the Corporation executing this release; that <br />Ruben Alvarado who signed this release on behalf of the contractor was then <br />Sales Mana a of said Corporation; that said release was duly signed for and on behalf of said <br />Corp ration by ority of its governing body, and is within the scope of corporate powers: <br />��ouwrrr <br />ecretary's Si ature o�!:A" p��� Notary Pub i S atteAofN G na <br />f -- : :o= Marshall C Corporate Seal <br />Matt Hostetler <br />Printed Name <br />•SEAL• c ounry <br />*S Commlaalon Number NP0744094 <br />My Commission Expires <br />°junnn"`� October03, 2030 <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 />Aa&� 2-44�61fy Date: 5/4/2023 <br />Co truction Manager <br />President <br />Member <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Member <br />Member <br />Member <br />Attest <br />