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CITY OF SOUTH BEND, INDIANA t <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 2022 Curb and Sidewalk Round 2 <br />PROJECT NO 122-044 FINAL COST $573,021.68 <br />CONTRACT SIGNED 12/13/2022 MAINTENANCE AGREEMENT ENDS 12/13/2025 <br />PROJECT DESCRIPTION Curb and siclewallc replacement and various locations <br />W ITN ES S 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 />Staff the City of So h Bend which were a part of the above Contract. <br />Exec its ' y f _ �� 12023 Prtrftw Senids <br />Company Name <br />S'b ature7�"- 61" -+12 e ehnnord sk <br />RI r l/u rn U e,,, Company Address <br />Printed N <br />buw +, to 4b516 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />T)M&� L-i , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the C Jay of , 202-3 <br />-PLN— <br />No ry Signature My Commission Expires I <br />�n 0FCTW rJ�� <br />Printed Name County of Residence CCNA AST <br />If the Contractor is a corporation, the following certificate will be executed. <br />h MGx VC'ILIN 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 />Ybf' tf of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Author of its governing body, and is within the scope of corporate powers: <br />Secretary's S iature <br />Corporate Seal <br />Ma Ve14w <br />Printed Nam— e <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: 3/18/2024 <br />—� IY <br />Construction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Breana N. Micou, Member <br />7�— <br />Attest: Laura D. Hensley, Acting Clerk <br />Date: March 26, 2024 <br />N <br />N <br />B _ <br />Z N <br />Q T <br />Z Q rn <br />U- Cl) <br />IY omp <br />wo <br />Z::i WWt` <br />m F - LL <br />OOaa(0WZ <br />� Z <br />Wa NZLU E — <br />CL <br />xCQ <br />W t-- w co <br />QZ OO2 <br />I—FJ5O <br />�cnU <br />2 � <br />Y � <br />w0 <br />U <br />