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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Demolition of 215 Johnson St <br />PROJECT NO 124-055 FINAL. COST 17OXOMOR $54,800 <br />CONTRACT SIGNED 41231205 <br />PROJECT DESCRIPTION Demolition of 215 Johnson St <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 e th' J� 4N day of —Ju17 e 1202 S Green Demolition Contractors, Inc <br />Company Name <br />Signaturr 315 Brighton St Ste. 1 <br />M1bht1t?( Company Address <br />Printed Name LaPorte, IN 46350 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />M.-. I�1aye.(J Bnaaaln and acknowledged his/her signature to the above Project 1 'o Afdavit on <br />the day .J Lin r✓ 2025_. JANET M COMMFR <br />Notary Public - Seal <br />Porter County • State of Indiana <br />Commisston !lumber MM746920 <br />N Si My Commission Expires t <br />Printed Name : County of Residence <br />If the Contractor is a co oration, the following certificate will be executed. <br />ro certify that I am Secretary of the Corporation executing this release; that <br />I J -0 In 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 />by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's gnature <br />r r Brpr Corporate Seal <br />tC A� JLr <br />Printed Name <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 />for <br />Construction manager <br />Date: 07/22/2025 <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />val�4 <br />Elizabeth A. Maradik, President <br />„21 <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />ME I <br />Joseph R. Molnar, Vice President <br />Breana Micou, Member <br />17 �u AB <br />Attest: Madeline Hostetler, Acting Clerk <br />Date: July 22, 2025 <br />