Change Order & PCA - South Well WT Plant Improvements Proj No 117-059B - C&E Excavating

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Lmi" CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS �•� r, tr �� PROJECT COMPLETION AFFIDAVIT �x� . •- ` �� PROJECT NAME South Well Field Water Treatment Plant and Distribution System Improvements - Contract B - Watermain PROJECT NO. 117-059B FINAL COST $1,584,808.37 CONTRACT 09-12-2023 MAINTENANCE AGREEMENT ENDS 7/31/2027 SIGNED PROJECT Installation of 20-inch diameter water distribution main and hydrants from DESCRIPTION South Well Field to Ireland Road through abandoned railroad corridor WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards ofthe City of South Bend which were a part of the above Contract. Execute is �_ day of Tc>��cu, , 20 2-S [ C&E Excavating, Inc. Signature Company Name Tea 3 '�3 e.551 nor' 53767 County Road 9 Printed Name Company Address Elkhart, IN 46514 City/State/Zip WITNESSES Before me, the undersigned Notary Public in and for said country and state, personally a ared , and acknowledged his/her signature to the above Project Completion ffic it on he day of , 202S NpJayS n lure My Commission Expires Printed Name County of Residence leit If the Contractor is a corporation, the following certificate will be executed. 1, certify that I am Secretary of the Corporation executing this release; that "T,k" 9,),e s , esoge, who signed this release on behalf of the contractor was then ]?rF,, A.-E — of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: ~_y-r _F ,r_• CRiSTOL MELODY VALDEZ Notary Public, State of India Secretary's Signature _'SEAL? E1khariCOunty Commission n 696906 Corporate Seal S� ►�O[l0.�iles sz1Lli.'^�^ Miy Comm,ssion Expi,es i Printed Name .. „., b �. �,� —1-4 DEPARTMENT OF PUBLIC WORKS APPROVAL This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: Construction Manager CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS VaA�4 Elizabeth A. Maradik, President Gary A. Gilot, Member — 4 7yt41-1 0 r t Joseph R. Molnar, Vice President Breana Micou, Member K441 Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: January 14, 2025