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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Brick Spot Repair <br />PROJECT NO 123-057 FINAL COST $202,970.75 <br />CONTRACT SIGNED 7/11/2023 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Spot brick repair multiple locations <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 />Ex ute� day of 4 ram`' , 202_. Acorn Landscaping <br />Company Name <br />mISSitNl DIoSL�S 680 n <br />Street <br />Address <br />Printed Name Alisa Simpson Soule Bend, IN 46619 <br />Notary Public Seal State of Indian <br />i I <br />St. Joseph County City State, Zip <br />WITNESSESS: My Commission Expires 12/18/2024 <br />efore me, the undersigneq Notary Public in and r s 1 o a d s e, personally appeared <br />Q C1'acknowledged s/her signature to the above Project Completion Affidavit on <br />e day ofn0 , 202. <br />Notary Signature My Commission Expires Z <br />P-c -1 V_,, <:� t rr-\ m,r--� 1--64, <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, , 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 />Corporation by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Corporate Seal <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 />tla(4 <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />�m <br />Joseph R. Molnar, Vice President <br />Breana N. Micou, Member <br />Murray L. Miller, Member <br />Attest: Laura D. Hensley, Acting Clerk <br />Date: March 26, 2024 <br />