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CITY OF SOUTH BEND, INDIANA Z, <br />BOARD OF PUBLIC WORKS y, <br />PROJECT COMPLETION AFFIDAVITA- <br />PROJECT NAME Northwest Elevated Tank Site Restoration <br />PROJECT NO 122-018A FINAL COST $31,759.00 <br />CONTRACT SIGNED December 19, 2023 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Site restoration of the Northwest Elevated Tank lot after damage from painting operations <br />WITNESSETH: of the tank. <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend which were a part of the above Contract. <br />Execu this 24 day of M 201 24 <br />Signature <br />Andrea Ritschard <br />Printed Name <br />Acorn Landscaping, LLC <br />Company Name <br />3680 W. Sample Street <br />Company Address <br />South Bend, IN 46619 <br />City, State, Zip <br />WITNESSESS: <br />B forme, th undersigned Notary Public in and for said country and state, personally appeared <br />}ZCI Z0.. i{ u[ and acknowledged his/her signature to the above Project Co v 5 i` cr alle L. Wnlak <br />;, r,� fSa er, FuNic, State of hKW <br />day of _ , 201� ;'i SEAL ga soseir, C r <br />Kru-) , * Nwitw NP075"14 J8 <br />,, , kk,, conmissionE,Vhe� o ary Signature My Commission Expires - <br />-e— <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 />Printed Name <br />Corporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project <br />is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />ILL V • !4 Date: 5/17/2024 <br />Project Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />W�a <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />J_ <br />Murray L. Miller, Member <br />11�___27r <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />/IAX. <br />Attest: Theresa M. Heffner, Clerk <br />Date: June 11, 2024 <br />