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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME <br />PROJECT NO. <br />Northwest Elevated Tank Rehabilitation Project <br />122-018 FINAL COST $1, l 85,155.00 <br />CONTRACT SIGNED August 9.2022 MAINTENANCE AGREEMENT ENDS <br />PROJECT Install new coatings for the Northwest Elevated Storage Tank as well. as <br />DESCRIPTION several minor site and structure improvements. <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 dernands <br />Nvhatsoever arising under or by such contract, and that the contractor performed the work within the scope of the <br />Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />Executed this 20th day of Ju1Y , 20 23 <br />Sigrr , <br />Serena Ee6 Stach <br />Printed Frame <br />VikinE Painting LLC <br />Company Name <br />PO Box 24162 <br />Company Address <br />Omaha, NE 68128 <br />City/State/7ip <br />WITNESS <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />and acknowledged his/her signature to the above Project Corn letion AF, (_1avit <br />-)n the day o , 20�3 DOMINIC PEDERSEN <br />General Notary - State of Nebraska <br />-- My Commission Expires Se 11 2026 <br />96 ary Signatu My Commission __ ires <br />h4c�i._i- It xtt:SI L <br />rintedName Countyof'Residence <br />If the Contrac corporation, the following certificate will be executed. �l <br />I _ certify that I am Secretary of the Corporation executing this release. that <br />who this release on behalf of the contractor waS ,hen <br />of said Corporation, aid release was duly signed for and on behalf of <br />said Corporation by Authority of its governing body, and is wr e 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 <br />ordained so. <br />Date: <br />Construction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />taLtk <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph <br />✓R. Molnar, Vice President <br />JordanV. Gathers, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: July 25, 2023 <br />