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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS r <br />PROJECT COMPLETION AFFIDAVIT x� PEACE ay <br />I� <br />PROJECT NAME Fun F/X Demolition 100 Sample Street <br />PROJECT NO. 123-014R FINAL COST $550 000 <br />CONTRACT 4/23/2024 MAINTENANCE AGREEMENT ENDS <br />SIGNED <br />PROJECT <br />DESCRIPTION <br />Demolition of 1000 W. Sample St. (Former Fun F/X Building) <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having <br />been completed, the City of South Bend, its officials and agents are hereby released from all claims and <br />demands whatsoever arising under or by such contract, and that the contractor performed the work within the <br />scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. <br />Executed this 61h day of November, 2024. <br />igna <br />Michae 3 Broueh <br />Printed Name <br />Green Demolition Contractors, <br />Inc. <br />Company Name <br />315 Brighton Street, Suite 1 <br />Company Address <br />Laporte, IN 46350 <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally <br />appeared M c L is eU fir, , and acknowledged hi/her signature to the above Project Completion <br />Affidavit on a day of av4t.4 , 20. <br />JANET M DOMMER <br />Notary Public - Seal <br />Nota Signatu�re My Commission Expires Porter County - State of Indiana <br />CO 116sion Number Npot74ttm <br />Jah e+ tit Gvl e r My Commission Expires Feb 16, 2031 <br />Printed Name County of Residence <br />If the Contractor is a core ration, the following certificate will be executed. <br />I, Hl'e qef Jmy , 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 />pr c!ae-(ew of said Corporation; that said release was duly signed for and on beb�alfof said <br />Corporatign by thority of its governing body, and is within the scope of corporate powers.' <br />Secrytaky, Si r = <br />Corporate Seal <br />,dam - , <br />Printed Nar6 <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 <br />ordained so. <br />,L.4�(v- Date: 11/18/2024 <br />Cockruction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Vila <br />Elizabeth A. Maradik, President <br />Gary A. Gilm, Member <br />7'z_^ I' 4 9­�' <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Briaann,((Micicou, Member <br />1 '"' "N <br />Attest: Theresa M. Heffner, Clerk <br />Date: November 26, 2024 <br />