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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Southeast Neighborhood Center (United Way) <br />PROJECT NO 119-093R FINAL COST $1,259,278.00 <br />CONTRACT SIGNED 7/27/2021 MAINTENANCE AGREEMENT ENDS <br />Site clearing and prep work for the new United Way building. Includes various aspects of <br />PROJECT DESCRIPTION new site work. <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 />Execp4d this 1 day of 202 3 The Robert Henry Corporation <br />! Company Name <br />Signature 404 S. Frances St. <br />n S_ Company Address <br />Printed Name South Bend, IN 46617 <br />City, State, Zip <br />WITNESSESS: <br />11jefore me 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 />e day of 202 <br />1 <br />Notary Signature My Commission Expires \ J 1 ffy A D 1 d{�� <br />LU o �6L I J)"1e—o5 <br />Printe County of Residence <br />If the Contrac or is a c rporation, the following certificate will be executed. <br />I, 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 />Cor p tion by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />�" ilia s a b lnti- <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: 11 /16/2023 <br />Cons tion Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />lau(4 <br />Elizabeth A. Maradik, President <br />�:? wM—WI <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: November 28, 2023 <br />:....Nor. <br />"n 0 <br />GG <br />-3 <br />`0r� <br />C OO -mod <br />�3zW0 <br />gym- � <br />rnID <br />N7 gn51 � <br />O < <br />CD <br />R <br />N QJi � <br />