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PROJECT NAME <br />PROJECT NO. <br />CONTRACT <br />SIGNED <br />PROJECT <br />DESCRIPTION <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS PEACE <br />PROJECT COMPLETION AFFIDAVIT x 1865 x <br />2023 Curb and Sidewalk <br />123-001 FINAL COST $956,974.57 <br />08/22/2023 MAINTENANCE AGREEMENT ENDS <br />Curb and sidewalk construction in South Bend (Divisions A, B, C, D, E) <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 />E cu this d of Nov K- , 20 a � <br />Premium Concrete Services, Inc. <br />Si nature Company Name <br />Becky Yeak y 712 Richmond Street <br />Printed Name Company Address <br />Elkhart, IN 46516 <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally <br />appeared 15cwJc.A w,4 Md acknowledged his/her signature to the above Project Completion <br />Affidavit on the day of VET► , 20�_. <br />No ry Signature My Commission Expires aOai(p <br />- M706)kief <br />Printed Name County of Residence ck� i a7 <br />If the Contractor is a corporation, the following certificate will be executed. <br />1, _ Marc Ye aq , certify that I am Secretary of the Corporation executing this release; that <br />&C 1w yf0-6i'l who signed this release on behalf of the contractor was then <br />PrPcsi Cior�� of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by A ority of its governing body, and is within the scope of corporate powers: <br />Se/c�r�eta s Signature <br />Corporate Seal <br />1 ' AV ye-ut Ll <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />9 <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it <br />e N <br />ordained so. <br />¢ r <br />z a <br />Date: 12/23/2024 <br />g; <br />ConsAction Manager <br />cr LLR�q <br />CD <br />J <br />SOUTH BEND BOARD OF PUBLIC WORKS <br />z W w CD <br />oM ..� cwn z <br />2aco UJ <br />}WW <br />President Member <br />fEz <br />wa COz °- g <br />zo �iLCQ <br />az ozM <br />Member Member <br />� 65 0 <br />_CS <br />Member Attest <br />J <br />w <br />