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CITY OF SOUTH BEND, INDIANA _, <br />BOARD OF PUBLIC WORKS +.. <br />PROJECT COMPLETION AFFIDAVIT. <br />PROJECT NAME VPA Splashpad Renovations <br />PROJECT NO 123-044 FINAL COST $497,809.38 <br />CONTRACT SIGNED 9/26/2023 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Removol and Replacement of South East Park and CoQuillard Park splash pads <br />WIT'NESSETH: <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 />Executed this 13 day of rCrb!'it6lrer 202 Premium Services <br />Company Name <br />Signatur 712 Richmond St <br />&y &dJ4q Company Address <br />Printed Name Elkhart, IN 46516 <br />City, State, Zip <br />ore me, he undersigned Notary Public in and for said country and state, personally appeared <br />p17( zV and acknowledged his/her signature to the above Project Completion Affidavit on <br />he 15"4-' day of FrBizu WA, 202 . <br />ry Signature My Commission Expires V owl91W <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed, <br />I, (3�y L VcW4.ir certify that I am Secretary of the Corporation executing this release; that <br />CfCWkA4 who signed this release on behalf of the contractor was then <br />r — vcf i of said Corporation; that said release was duly signed for and on behalf of said <br />Col ion by uthor' of t go ping body, and is within the scope of corporate powers; <br />S tary's Sig tur <br />Corporate Seal <br />w u <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable for final approval and we recommend to (lie Board of Public Works that it be ordained so. <br />XlaA .L-44a!�e,6.4V. Date: 6/4/2025 <br />Cor ruction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />f Arm / ac-hn� <br />Murray L. Miller, Member <br />Attest: Hillary Horvath, Acting Clerk <br />Date: 6/24/25 <br />