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CITY OF SOUTH BEND, IND.IANA �y <br />BOARD OF PUBLIC WORKS - <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Our :Lady of Hungary Tree Removal <br />PROJECT NO 122-007B FINAL COST $27,390.00 <br />CONTRACT SIGNED 2/13/2024 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Tree removal in Our Lady of Hungary neighborhood <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 />Executed this �2 4 day of rJA 12024 K&R Tree Service <br />Company Name L <br />gna a 1124 a j:'J's <br />' Compa Address jr <br />Printed Name 'Sc' L-4pek I i <br />City, State, Zip <br />WITNESSESS: <br />_Aare me, a uncle i ed Notary Public in and for said country and state, personally appeared <br />`[�[�1j'("wj and acknowledged his/her signature to the above Project Completion Affidavit on Mdbw <br />the 01 day of 202_HANGIE WRIGHT <br />Notary Public - Seal <br />St J sa County - State of Indiana <br />Not Signa&re My Commission Expires umber NP0746217 <br />031 <br />Printed NarAe County of Residence , , <br />If the Contractor is a corporation, the following certificate will be executed. <br />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 />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: <br />Construction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />vl�a <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />q 4 7-11- <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: April 23, 2024 <br />