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r <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Four Winds Ficld Pia er Facili Improvements <br />PROJECT NO 122-021 FINAL, COST $1,411,868.00 <br />CONTRACT SIGNED 10/11 /2022 MAINTENANCE, AGREEMENT ENDS <br />PROJECT DESCRIPTION Visitor locker room cx ansion, female locker room addition, and several room update.. <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 />Fxe • this h day of May 20Z3 Gibson-I.ewis, LLC <br />Company Name <br />sign tune _ loot W. 1 I th St. <br />Robert A 1_ingenfelter Company Address <br />Printed Name Mishawaka, IN 46544 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Robert A. Lingenfelterand acknowledged his/her, signature to the above Project Completion Affidavit on <br />the 5 day ;fM �.2 3 <br />Notary Sitnaturc My Commission Expires 7/10/24 <br />Elizabeth A Biddle <br />Printed Namc . County of Residence St. Josel]h <br />If the Contractor is a corporation, the following certificate will be executed. <br />h , 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 />Printed Name <br />Corporate Seal <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: 8/9/2023 <br />Co traction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />VILa <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />IND <br />J(osepph� (� <br />R..Molnar, Vice President <br />avL� <br />Alexandra Dolz-Lane, Member <br />4 <br />Attest: Theresa M. Heffner, Clerk <br />Date: August 22, 2023 <br />