Change Order No 1 & PCA - Pinhook WTP Guaranteed Savings Contract Proj No. 119-003 - Bowen

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CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME Pinhook WTP Improvements - Guaranteed Energy Savings Contract PROJECT NO 119-003 FINAL COST $1,784,530.00 CONTRACT SIGNED FebruaEy 9 2021 MAINTENANCE AGREEMENT ENDS PROJECT DESCRIPTION Water treatment plant improvements includins filter rehabilitation and other plant component WITNESSETH: replacements or repairs The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. Executed this 28th day of __ August .20 23 Signature Pat Stanford, Project Manager Printed Name Bowen Engineering Corporation Company Name 8802 N. Meridian Street Company Address Indianapolis, IN 46260 City, State, Zip WITNESSESS: Before me, the undersigned Notary Public in and for said country and state, personally appeared Pat Stanford , and acknowledged his/her signature to the above Project Completion Affidavit on the 28th day of August , 20 23 June 4, 2024 Notary Signature My Commission Expires Margaret Burroughs Printed Name County of Residence Newton `Sr ��■��nrnnrr If the Contractor is a corporation, the following certificate will be executed. ,..■ "'►., I, Carey Weddle certify that I am Secretary of the Corporation executim'�IC5A� �[Pat Stanford who signed this release on behalf of the con#a {3 .�'; Pr Manager of said Corporation; that said release was duly signed ]rt; d behalf of sea'. -;per Corporation by Authority of its governing body, and is within the scope of corporate powers: ; �; j : Q � o : C) Sec tary's Signature V Carp*ate SealQ Carey Weddle r d CJ/AtV N Printed Name '•,�� ' • ... • ��L �,.• DEPARTMENT OF PUBLIC WORKS APPROVAL ��''+■�Arr�►+►'`� This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: Construction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS VlLa Elizabeth A. Maradik, President Gary A. Gilot, Member 11,;,M 14 V I Joseph R. Molnar, Vice President Alexandra Dolz-Lane, Member Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: September 12, 2023