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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME <br />MarMain Apartments Roof Replacement <br />PROJECT NO <br />122-061 FINAL COST $484,062.00 <br />CONTRACT SIGNED <br />2/14/2023 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION <br />Roof Replacement at MarMain Apartments <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 />Execu ed this 1 day of _December 20X 23 <br />S' nature <br />Michael Jackson <br />Printed Name <br />Slatile Roofing and Sheet Metal Co. Inc. <br />Company Name <br />1703 S. Ironwood Dr. <br />Company Address <br />South Bend, IN 46613 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared \��`LI C <br />Michael Jackson and acknowledged his/her signature to the above Project Completion Affidavi", nr •.• ' 6'% <br />the 21 st day of December 2023 z. <br />=Q. Q p <br />Notary S&AtAire My Commission Expires �L42s/i/U3c� ; O CO c. <br />n <br />Amy Marquez <br />Printed Name County of Residence �/ '%,STA1.,, <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Ann Longemt certify that I am Secretary of the Corporation executing this release; that <br />Michael Jackson who signed this release on behalf of the contractor was then <br />Controller h i i/of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its governlrlg bodand is within the scope of corporate powers: <br />Q Corporate Seal <br />Ann Lon erot 2 LU <br />Printed Name <br />DEPA TMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final,approvol,and'we recommend to the Board of Public Works that it be ordained.so. <br />Date: 1 /2/2024 <br />Co truction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />vl� (4 �Tt <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member <br />772wy � <br />Briana Micou, Member <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: January 9, 2024 <br />