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CITY OF SOUTH BEND, INDIANA M► <br />80ARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Curb and Sidewalk Round 1 Div 1 + 2 <br />PROJECT NO 122-001 FINAL COST $618 546,38 <br />CONTRACT SIGNED 7/2612022 MAINTENANCEAGREEMENT ENDS <br />PROJECT DESCRIPTION Curb and Sidewaik replacement at various locations <br />WITNESSETH: <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 co and that the actor performed the work within the scope of the Specifications and Standards of the City <br />of Sauth�n which were a 43s of the above Contract. <br />Executed 5 of J 2i1�3 Milestone Name <br />North <br />Company Nae <br />F - 24366 State Road 23 <br />Printed Name <br />Company Address <br />South Bend IN 45614 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personaltyElm appeared AL1SIiAFfRt1EGER <br />and acknowledged his/her signature to the above Project Con[,... o; My Cornnrission Expires <br />the day f 20'F 23 SEAL • June 5, 2030 <br />'�. =ale Commission Number NP0653544 <br />'.'FvFe La Pate County <br />Note �gnature My Commission Expires 6/5/203 <br />Alisha Krue er <br />County of Residence LaPorte <br />Printed Name <br />If the Contractor is a corporation, the following certificate will be executed. <br />I• Danielle Payne certify that I am Secretary of the Corporation executing this release; that <br />1IIIr►I <br />Dustin P. Hilo who signed this release on behalf of the co ntracto r was tF j ►►►► <br />D of said Corporation; that said release was duly signed for and on t�'I�C�I6dt�..idfo s•���f <br />Corporation by Aut ty of its governing body, and is within the scope of corporate powers: ��'��= • ......... <br />• c ;�o��' <br />�, CRGTF S <br />Secretary's Signature - 1cXrA <br />:.r} <br />Danielle Pa ne <br />'e. <br />Printed Name •r�i �NbICIN�• �����•= <br />DEPARTMENT OF PUBLIC WORKS APPROVAL •��►►f! I l ill►��� <br />This project Is acceptabie to final approval and we recommend to the Board of Public Works that it be ordained so. <br />Z a Z44� Date: <br />C struction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Joseph R. Molnar, Vice President <br />Jordan V. Gathers, Member <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: July 25, 2023 <br />