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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS] <br />PROJECT COMPLETION AFFIDAVIT' <br />PROJECT NAME Micro -Surfacing <br />PROJECT NO 124-049 FINAL COST $106.804.65 <br />CONTRACT SIGNED 7/23/2024 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Micro -Surfacing: Edison, Scenic, Mayfair and additional spots throughout City <br />WITNESSETH: <br />fhe 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 />Lxecuted this s� day of_Qet�o%v 202_' Asphalt Restoration Services <br />Company Name <br />tr ure PO Box 2484 <br />Company Address <br />Printed Name <br />WITNESSESS: <br />202. <br />Notary Sfgnature My Commission Expires <br />t <br />Printed Na:ne County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />South Bend. IN 46680 <br />City, State, Zip <br />�,, DANA TROWBRIDGE <br />1?.••••,9�%; Notary Public, State of Indian <br />° St. Joseph County <br />==:SEALi"" <br />o <br />c Cmmission Number NP071788 <br />••••N My Commission Expires <br />January 02, 2027 <br />lit <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 Na_rtte <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />Corporate Seal <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />u ,L_60&6V_ Date: 11 /26/2024 <br />Co truction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />G� <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R`.-Mo�lnaarr, Vice President <br />Briana Micou, Member <br />Ot <br />Attest: Theresa M. Heffner, Clerk <br />Date: December 10, 2024 <br />