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amb ee <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS ,R <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME 510 S. Main Street Building Improvements <br />PROJECT NO 119-084 FINAL COST $161 162.96 <br />CONTRACT SIGNED 9/10/2019 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Winter improvements to the building located at 510 S. Main St. <br />WITNESSETH: <br />The work under the above contract between the City of South Bend and the undersigned contractor having been completed, <br />the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City <br />of South Bend which were a part of the above Contract. <br />Executed,t 4 day of AI-4)("m , 2011 _ HC3 LLC d/b/a St. Clair Development <br />Company Name <br />Signature P.O. Box 6114 <br />-C,— / Company Address <br />Printed Name South Bend, IN 46660 <br />City, State, Zip <br />WITNESSESS: <br />Before me the undersigned Notary Public in and for said country and state, personally appeared <br />and acknowledged his/her signature to the above Project Completion Affidavit on <br />the t�, day of ) O �r� m6_r _, 201 9 <br />Notary Signature I My Commission Expires L2 <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, 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 by Authority of its governing body, and is within the scope of corporate power NOTARY P(JISLIC . STATE OF INOIANA <br />SEAL <br />Secretary's Signature ANNETTE FARTHING <br />COMMISSION NUM a S 9al <br />MY COMMISSION EXPIRES JUKE 17, 2026 <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable f� fi I approval and we recommend to the Board of Public Works that it be ordained so. <br />w w �� , Date: o,3 as <br />Constructlo ger <br />r " <br />Gary A. GI ot„ resident <br />herese J. D66u, 6ber <br />BOARD OF PUBLIC WORKS APPROVAL Date: i /Z-/ ( 11 <br />Genevieve E. Miller, Member <br />Laura L. O'Sullivan, Member <br />aradik, Member <br />M. Martin, Clerk <br />