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PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT <br />Micro-Surfacing <br />124-049 FINAL COST $106 804.65 <br />7/23/2024 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Micro-Surfacing: Edison, Scenic, Mayfair and additional spots throughout City <br />WITNESS ETH: The work under the above contract between the City of South Hend 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 />·:;..,;;�I'-�-+_ day of {)t:.fu',o,,_v , 202 'f Asphalt Restoration Services <br />Printed Name <br />My Commission Expires <br />Company Name <br />PO Box 2484 <br />Company Address <br />South Bend IN 46680 <br />City, State, Zip <br />,,,,111111,,,, DANA TROWBRIDGE <br />.::-'�.,_�;.�u;',,,,_ Notary Public, State of Indiana {�/ \�1 St. Joseph County <br />�*:_SEAL,: * g Commission Number NP0717688 <br /><, ; •· -·� /' My Commission Expires <br />111 1111 ,, ' <br />January 02, 2027 <br />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 />St: cretary's Signature Corporate Seal <br />Printed Na.'11e DEPARTMENT OF PUBLIC WORKS APPROVAL This prnject is acceptable for final approval and we recommend to the Boa.rd of Public Works that it be ordained so. <br />Date: <br />Construction Manager SOUTH BEND BOARD OF PUBLIC WORKS President Member <br />Member Member <br />Member Attest <br />11/26/2024 <br />December 10, 2024