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:yap_''%_ <br />CITY OF SOUTH BEND, INDIANA ` <br />pal .1u� 4�ij <br />BOARD OF PUBLIC WORKS;: <br />PROJECT COMPLETION AFFIDAVIT,;; .y <br />PROJECT NAME 2021 Demolitions <br />PROJECT NO 121-036 FINAL COST $362,670.00 <br />CONTRACT SIGNED 1/11/2022 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 d this day of J ofte 20 �'-� Green Demolition Contractors, Inc. <br />Company Name hSignat re � � r <br />Sup e <br />Co m any Ad c rreess <br />Printed Name Lg46364 <br />br-tz T-r( �6356 <br />City, State, Zip <br />WITNESSESS: <br />Before me, under 'gned Notary Public in and for said country and state, personally appeared <br />JgSoh Jeny�, and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 21 s day of Jvh e- , Zei Zo23, <br />Notary f <br />nature II AA My Commission Expires <br />�41ge+ AA �oatwe f( <br />Printed Name County of Residence <br />JANET M OOMMER <br />Notary Public - Seal <br />Porter County - State of Indiana <br />Commission Number NP0746920 <br />My Commission Expires Feb <br />If the Ccnt(acto( is a orporblfcp <br />, the following certificate will be executed. <br />C t�R . del certify that I am Secretary of the Corporation executing this release; that <br />o who signed this release on behalf of the contractor was then <br />I C e o o aid Corporation; that said release was duly signed for and on behalf of said <br />yi Corporation b of ' governin dy, and is within the scope of corporate powers: <br />C� Corporate Seal <br />A4 4 el ,J. rcug ln <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 />&& ,L-uw- Date: 7/5/2023 <br />Con ruction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member Jordan V. Gathers, Member <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: July 25. 2023 <br />