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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT e' <br />PROJECT NAME Riverside Shoulder Repair <br />PROJECT NO 124-059 FINAL COST $17,569.00 <br />CONTRACT SIGNED 10/22/2024 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Removal of asphalt, replaced with topsoil and seed. Sidewalk extension. <br />WITNESSETH: <br />The 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 />E cute this `t).0 t day of 202Acorn Landscaping <br />Company Name <br />Si ftr <br />3680 West Sample St. <br />Sc ar Company Address <br />Printed Name South Bend, IN 46619 <br />City, State, Zip <br />WITNESSESS: <br />Notary Public in and for said country and state, personally appeared <br />I acknowledged his/her signature to the above Project Completion Affidavit on <br />My Commission Expires <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, <br />JoAnna Vitale <br />Notary Public Seal State of Indiana <br />Marshall County <br />Commission Number NP0739664 <br />My Commission Expires 31812030 <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 Name <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 />t Date: 12/27/2024 <br />Co ction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />C� <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />'f,o", 4 <br />Murray L. Miller, Member <br />Joseph R. <br />Molnar, Vice President <br />Breana Micou, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: January 14. 2025 <br />