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4 SouTif Ul <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS •G <br />PROJECT COMPLETION AFFIDAVIT ,P'll,{� <br />X <br />1865 <br />PROJECT NAME Drewer 's Brewery <br />PROJECT NO. ­0 C,,, FINAL COST $447,827.83 <br />CONTRACT ,Id J— 0 , MAINTENANCE AGREEMENT ENDS <br />SIGNED <br />PROJECT <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 fiom 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 ofthe above Contract. <br />Execute of <br />Si nature Company Naive <br />PC- ro 3q--3 ►�n�lc► fey �U-e, <br />Printed Name Company Address <br />(5- 1 n cL 1 <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally <br />appeared MarIL65It r , and acknowledged his/her signature to the above Project Completion <br />Affidavit on the Zq41n day of Qcka b e—r , 20 :O . <br />Notary Signature My Commission Expires 2-0 3 d <br />Printed Name County of Residence <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, V-- 0S.L0'�D� , 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 />iC �1 of said Corporation; that said release was duly signed for and on behalf of said <br />Corpo n ri o its goveMin body, and is wither the scope of corporate powers: <br />Secretary's Signature Corporate Seal <br />Printed Narne <br />gDIEPAR'TMEI`1T OF PIUBLllC 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 />&"A ,L-44a!�elu'- Date: <br />C struction Manager <br />11 /18/2024 <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />ta�q <br />Elizabeth A. Maradik, President <br />4'." aft <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: December 10, 2024 <br />