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CITY OF SOUTH BEND, INDIANA <br />[BOARD OF PUBLIC WORKS <br />� <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME <br />Neighborhood Improvements- Longfellow and South <br />PROJECT NO <br />121-048B FINAL COST $521,159.99 <br />CONTRACT SIGNED <br />MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION <br />Construction of intersection improvements at Longfellow Ave. and South St. in South Bend <br />1►��IY�4�'�'3�r:lr <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 />� <br />Executed thi day of JU% r/ _, 20 Z -( `) r-d ' �`{ _�11 <br />Company Name <br />ignature ZS-zoo S. R. Z3 <br />(C41VI Company Address <br />Printed Name &1&'(' 1)i <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />'DeaV.. SCL(, r and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 'j day of NM,uwJkae c , 2024, <br />Notary Signature My Commission Expires <br />7) <br />1•cAc,Ya6_eA <br />Printed Name County of Residence Olarsb� <br />If the Contractor is a corporation, the following certificate will be executed. <br />I,cL4 46s+eiuk certify that I am Secretary of the Corporation executing this release; that <br />�e+re it 'sawwho signed this release on behalf of the contractor was then <br />2r0AeCt Mei n uo.GX of said Corporation; that said release was duly signed for and on behalf of said <br />Corpo ation by Aut ty of its governing body, and is within the scope of corporate powers: <br />A.11RACHAEL ELLIS <br />\N <br />e% Notary Public, State of Indiana <br />Se r a 's S gna o?• %<— <br />SEAL;"- Marshall County Corporate Seal <br />n. -h k��,,,1e/ „*'•, * My Commission es <br />� Commission Number Expires <br />Printed Name � i'IpNP\` October03, 2030 <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />/A zz �w- Date: 11/18/2024 <br />Coi�truction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />pzr.", ' / <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Breana Micou, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: February 11, 2025 <br />