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��SouTII eF�o <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS c <br />PROJECT COMPLETION AFFIDAVIT <br />X` Y <br />Il� <br />PROJECT NAME Studebaker Museum HVAC Replacement <br />PROJECT NO. 124-020 FINAL COST $84,400.00 <br />CONTRACT December 171h, 2024 MAINTENANCE AGREEMENT ENDS <br />SIGNED <br />PROJECT Replacement of two HVAC units at the Studebaker Museum. <br />DESCRIPTION <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 />Executed this t day of , 20� <br />z <br />Signature <br />�4\�Q\zje-f\� k 11i�, v' c v\-N q 11 <br />Printed Name <br />rlwan w <br />Company Name <br />54 f9 K. ttyr-ft �f <br />Company Address <br />kE&h41W0A0^ irf Al•S44C <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said co <br />appeared KA}I&IM k rrry n , and acknowledged his/her signature to th a4Mgy �,c��i `nn�t�P4},diana <br />Affidavit on the 11 day of XJA A 04 E, 20_3,5 S1, Joseph County <br />Commission Number NP0750192 <br />My Commistion Expires 071i6l2031 <br />Sign Lure r _ My Commission Expires /1 b/ it i <br />Printed Name County of Residence S�, J'a eo/" <br />If the Contractor is a corporation, the following certificate will be executed. <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 b?y Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature Corporate Seal <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 <br />ordained so. <br />Date: 8/14/2025 <br />Con.&Auction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />1W14 <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />7y2,,,,y 4 9-114+ <br />Joseph R. Molnar, Vice President <br />Breeaannuaa M�� icou, Member <br />(/ f <br />Murray L. Miller, Member <br />Attest: Hillary R. Horvath, Clerk <br />Date: 8/2612025 <br />