Laserfiche WebLink
n o _ <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS =, <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Dubail Street Sidewalk <br />PROJECT NO 124-009B FINAL COST S 13,676.00 <br />CONTRACT SIGNED 4/9/2024 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Constrict sidewalk on Dubail St. between Philippa and Olive <br />WITNESSETH: <br />he 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 />i;x,etrted this 5' day of -Ju.r1C 202-` <br />Signature <br />�rikko. M0.Yi1-V1CZ <br />Printed Name <br />Ortiz Construction <br />Company Name <br />1525 Magnolia St <br />Company Address <br />South Bend, IN 46613 <br />City, State, Zip <br />WITNESSESS: <br />More me, the undersigned Notary Public in and for said country and state, personally appeared <br />1V*9k 90►rr+YIZi and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 3 rcl day of v .20214 <br />lsiutary Signature My Commission Expires �O <br />[� rr1 G I S�ylvt C...ti <br />Printed Name County of Residence', <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 by Authority of its governing body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Printed Name <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />Corporate Seal <br />This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: 6/4/2024 <br />Co traction Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />VILa <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />M <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: June 11, 2024 <br />vn <br />to N <br />w <br />Q c� ¢ in <br />�Uca 0 <br />H_Jft�ZZ0S <br />Z05 05Cr <br />w <br />z —M <br />aaQ2 <br />w <br />ou3�F- <br />�z0Ow <br />< <br />4 Q�Q x <br />r LLI <br />0 <br />