PCA - Indiana Earth, Inc. - Demo of Vacant & Abandoned Houses Phase VII Div B

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PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION W ITN ESSETH: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT Phase VII Division B 171 10/27/2015 Demolition of Vacant and Abandoned Houses, Phase VII Division B The work under the above contract between the City of South Bend and the undersigned contractor having been completed, the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under or by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the City of South Bend which were a part of the above Contract. V day of SUC-y 201 G MMe r;SlxEZ VrZ�SF .ifr Printed Name Indiana Earth, Inc. Company Name 10343 McKinley Hwy Company Address Osceola, IN 46561 City, State, Zip WITNESSESS: Before me, the undersigned INry Public in and for said country and state, G Lb - , and cknowledged his/her signature to the above P the 24'L ay of ti i 201 �- Notary Signature My Commission Expires Lc-ttu S�JS Printed Name County of Residence If the Contractor is a corporation, the following certificate will be executed. Y-- G�lE C Printed Name personally appeared certify that I am Secretary of the Corporation executing this release; that who signed this release on behalf of the contractor was then of said Corporation; that said release was duly signed for and on behalf of said 07, and is within the scope of corporate powers: DEPARTMENT OF PUBLIC WORKS APPROVAL Corporate Seal This project is acceptable for final approval and we recommend to the Board of Public Works that it be ordained so. Date: —►• 2.S • I(, Constructio tmy Hager n / BOARD OF PUBLIC WORKS APPROVAL Date: zt� � h GaryA. Gilot, President DaVid P. Relos, Member Elizabeth A Maradik, Member Therese Dora , M&tber James A. Mueller, Member L' M. Martin, Clerk