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CITY OF SOUTH BEND, INDIANA Ae Q <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2022 Contractor Paving, Round 3 <br />PROJECT NO 122-048 FINAL COST $2,419,480.43 <br />CONTRACT SIGNED 11/8/2022 MAINTENANCE AGREEMENT ENDS <br />Pavement updates along Miami St between Calvert St and Ireland Rd, and Sample St <br />PROJECT DESCRIPTION between Bendix Dr and Illinois St. <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 />Execs thi, cl,�v of 202 :5 Rieth-Riley Construction Co., Inc. <br />j/ (/ Company Name <br />Signature 25200 State Road 23 <br />Ruben Alvarado, Sales Manager <br />Printed Name <br />WITNESSESS: <br />Company Address <br />South Bend, IN 46614 <br />City, State, Zip . <br />���u�uuq... <br />`�.% �rav �►� �.RACMAEL M C2AR-N <br />f.a� % Notary Public, State of Indiana <br />Before me,t1� vary a and reoigned Notary Public in and for said country and state, personally ap EAL;"T Marshall County <br />Ruben Al c� _,�e;�.� *: Commission Number NP0744094 <br />, and acknowledged his/her signature to the above Project Completi y4s'�t��oon My Comrnlsalon Expires <br />October03, 2030 <br />�ofday +—, 202_. <br />Notary Signature My Commission Expires 10/03/2030 <br />Rachael Czarnecki <br />Printed Name County of Residence Marshall <br />If the Contractor is a corporation, the following certificate will be executed. <br />I Matt Hostetler certify that I am Secretary of the Corporation executing this release; that <br />Ruben Alvarado who signed this release on behalf of the contractor was then <br />Sales Manaizer of said Corporation; that said release was duly signed for and on behalf of said <br />Corpor on by Aullority of its governing body, and is within the scope of corporate powers: <br />Secretary's Sijp-dt6re <br />Corporate Seal <br />Matt Hostetler <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 />Date: 11 /2/2023 <br />Co uction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />tjlLa "�-rt <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member Alexandra <br />Dolz-Lane, Member <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: November 14.2023 <br />