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BENJAMIN MARLATT <br />Notary Public \ <br />State of Indiana <br />Commission No. 711569 <br />My Commission Expires <br />March 22, 2026 <br />PROJECT NAME <br />PROJECT NO <br />AGREEMENT SIGNED <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />~\S.'-S>S3,~s c.-c~-H\.;'ic; ~o..U\""'-.c=, "b . t,y"2.\-oc7 <br />FINAL CO~ $ '3\::1\,. 1 ; cM,· '-\S <br />MAINTENl>iAGREEMENT ENDS <br />The work under the above agreement between the City of South Bend and the undersigned owner having been completed, <br />the City of South Bend. its officials and agents are hereby released from all claims and demands whatsoever arising under <br />or by such agreement, and that the owner performed the work within the scope of the Specifications and Standards of the <br />City of South Bend which were a part of the above agreement. i>R,~ .. \...~ 4 ('lo lo... <br />Executed th:.: "'l..~ day of 't"\~'i, 'l...~"2..~. ~b~~,"'\>P\'-\"''i. ~~~-r-,..,.,.,rc ~c:a~p ~-\ L. Company Name ¾ruYe S'~~ '"'\,'-¼~~~';::.\..:,_;) '°' 0 \t..,. ~~""'-'-Company Address <br />Printed Name '°"\-.,~ \J (',..P., ~OOb~ <br />City, State, Zip <br />WITNESSES: <br />BQfi>re me, the undersigned Notary Public in and for said country and state, personally appeared <br />::J" I f" e<....:l \(.. A-~ e:.l....-and acknowledged his/her signature to the above Project Completion Affidavit on <br />~~~~>.?, <br />Nola · re My Commission Expires M 22, 2-0 2'. <br />~~,...J Mt:rf4J'WC <br />Printed Name County of Residence <br />If the owner 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 governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Corporate Seal <br />Printed Name <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 />BOARD OF PUBLIC WORKS APPROVAL Date: ________ _ <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President Gary A. Gilot, Member <br />Murray L. Miller, Member Jordan V. Gathers, Member Theresa Heffner, Clerk <br />June 27, 2023