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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Southeast Park Playground Resurfacing <br />PROJECT NO 123-043 FINAL COST $261,000.00 <br />CONTRACT SIGNED 07-11-2023 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Replacement of PIPSurfacing at the Southeast Park Playground <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 />��ards of the City of South Bend which were a part of the above Contract. <br />Execlated,lbis 2nd day of o ember .2023 Sinclair Recreation <br />Company Name <br />Signature 176 E. Lakewood Blvd. <br />Diane Sinclair <br />Printed Name <br />Company Address <br />Holland, MI 49424 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Diane Sinclair , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 2nd day of November 2023 <br />Notary Signature My Commission Expires j,?XL9q <br />Scott Bareman <br />Printed Name <br />County of Residence Ottawa <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, Richard Sinclair certify that I am Secretary of the Corporation executing this release; that <br />Diane Sinclair who signed this release on behalf of the contractor was then <br />President of said Corporation; that said release was duly signed for and on behalf of said <br />C oration by u ority f its governing body, and is within the scope of corporate powers: <br />Secretary's SiOUL&A <br />Corporate Seal <br />Richard Sinclair <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: <br />Construction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />1at� a <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Briaannal�Miicou, Member <br />� ./`' <br />Attest: Theresa M. Heffner, Clerk <br />Date: November 28, 2023 <br />