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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />2023 Tree and Stump removal for curb and sidewalk contract <br />123-002 FINAL COST $33,105.02 <br />5/23/2023 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Tree removal, stunip grinding <br />W1TN ESS ETH: <br />The work under the above contract between the City of -South Bend and the undersigned contractor having been <br />completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever <br />arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and <br />Standards of the City of South Bend which were a part of the above Contract. <br />Executed this :?T day of SQ p , 202 3 <br />Si azure <br />i KY0r) e y <br />Pri ted Name <br />K & R Tree Service <br />C$mp?7AmJr taffy rt T {'• <br />Company Address <br />South Bend, 1N4660+ <br />City, State, Zip <br />WITNESSESS: <br />.Before a the undersigned Notary Public in and for said country and state, personally appeared <br />and acknowledged his/her signature to the above Project Completion Affidavit on <br />ie � day of T° 202 7 Eh <br />RLYNE 7OOM8f <br />ary Public -Seal <br />Nola Si nalu M Commission Expires Jun - State of Indiana <br />oxY' 6 Y P lion r NP0659713 <br />lll on Lxptres Nov 12, 2030 <br />Printed Nan Cowity of Residence CZ <br />If the Contractor is a corporation, the following certificate will be executed,. <br />1, 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 />Al 64-)- Date: 10/3/2023 <br />Cons&dction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />takL �k <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />7j2wy 4 , <br />M, <br />Joseph R. Molnar, Vice President <br />u aw->" <br />Alexandra Dolz-Lane, Member <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: October 10, 2023 <br />