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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS , t <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Erskine Well Variable Frequency Drive Installation <br />..... PROJECT NO. � 119-032 FINAL COST $6,175.00 _....... <br />CONTRACT SIGNED 5/28/2019 MAINTENANCE AGREEMENT ENDS N/A <br />PROJECT DESCRIPTION Install variable frequency drive on waterpu_ rnp in Erskine well house <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 _ day of _ I� , 20�_. <br />�. �.. <br />��... ��._...�.... HermanGoetz, Inc. <br />Signatut Company Name <br />225 S. Lafayette Blvd. <br />Printed Name Company Address <br />South Bend, IN 46601 <br />City/State/Zip �. <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />-Geaxg -E , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the L9 hday of guat .__, 201 9 <br />rotary Sgnataa mm My Commission Expires 7 <br />Catherine J. Gruber <br />Printed Name µ _ County of Residence S t . Jose <br />If the Contractor is a corporation, the following certificate will be executed. <br />I Kathleen A. Herrm r rtif that I am Secretary of the Corporation executing this release; that <br />George Ernsberge11 r who signed this release on behalf of the contractor was then <br />Project Manager of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation b Autho •'ty f `ts gc verni�ng body, and is within the scope of corporate powers: <br />Scera� <br />K Signature <br />Corporate Seal <br />��.exr..AH ....__....___ <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: 7/23/2019 <br />Project er <br />BOARD OF PUBLIC WORKS APPROVAL <br />Ga , Gilot, Pr id ^ t ' Genevieve E. Miller, Member <br />Laura L. O'Sullivan, Member "1`hca•ese�01r,,1�6,tMembcr <br />Date: 7LXWO <br />/ <br />Elizaabcth A. Maradik, Member <br />M. Martin„ <br />