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CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME _Traffic FLIR Cameras at Portage, Forest and Lamonte <br />PROJECT NO 115-101 FINAL COST $31,000.00 <br />CONTRACT SIGNED 6/23/2016 MAINTENANCE AGREEME <br />PROJECT DESCRIPTION New Traffic FLIR Cameras at Portage, Lamonte, and 5 <br />WITNESSETH <br />The 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 />Executed this 2 9 t h dayof Aug1j.9t 2016 Michiana Contracting, Inc. <br />d � -i !2. Company Name <br />Signature PO Box 929 <br />David J. Delo <br />Company Address <br />Printed Name <br />Plymouth, IN 46563 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Da v i d J . Dp 1 np, and acknowledged his/her signature to the above Project Completion Affidavit on <br />the 29th da,201 6 <br />otaySignature My Commission Expires March 27. 2022 <br />Andrea Jae Fisher <br />Printed Name County of Residence Marshall <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Pamela S. Delp certify that I am Secretary of the Corporation executing this release; that <br />DR it i &T n e 1 P who signed this release on behalf of the contractor was then <br />Vice President of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Authority of its erni body, and is within the scope of corporate powers: <br />Secretary's Signature <br />Pamela S. Delp <br />Printed Name <br />,orporate Seal <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable f r al approval and we recommend to the Board of Public Works that it be ordained so. <br />Date: <br />Construction &ger �1 <br />BOARD OF PUBLIC WORKS APPROVAL Date: ! /� 3/ IG <br />G ry A. Gilot, President �aZ�id P. Relos, ber Elffalbeth A Maradik, Member <br />Therese J. DOfau,mber James A. Mueller, Member �L�+ da M. Martin, Cle k ` <br />