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fSpurN ggry <br />CITY OF SOUTH BEND, INDIANA F: <br />BOARD OF PUBLIC WORKS "U <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME Lafayette Falls Subdivision Pavement <br />PROJECT NO 115-086 FINAL COST $260,694.00 <br />CONTRACT SIGNED 6/14/2016 MAINTENANCE AGREEMENT ENDS <br />PROJECT DESCRIPTION Work includes Dlacement of the HMA surface Davement and adiustino all castings to grade <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, 0 officials and agents are hereby released from all claims and demands whatsoever arising under c <br />by such contro�l1 and at the contractor performed the work within the scope of the Specifications and Standards of the Cit, <br />of South Bgn'4hiq"ere a part of the above Contract. <br />day October 2016 Walsh & Kelly <br />Company Name <br />t y <br />24358 State Road 23 <br />Area Manager Company Address <br />e South Bend, IN 46614 <br />City, State, Zip <br />WITNESSES: <br />Before me, the undersigned Notary Public in and for said county and state, personally appeared <br />Dustin Hilary , and acknowledged his/her signature to the above Project Completion Affidavit on <br />Printed Name <br />If the Contractor is <br />2016 <br />Commission Expires May 4, 2018 <br />St. Ja h county unty of Residence St Joseph <br />R86/ItSt��.i3rlate ill be executed. <br />I, J Michael Schaff - t I am Secretary of the Corporation executing this release; that <br />Dustin Hilary who signed this release on behalf of the contractoJ WAt1t"0n,, <br />Area Manacier of said Corporation; that said release was duly signed for,oFi61Pod <br />Cor rati Autho 0of governing body, and is within the scope of corporate powers: ` r : ' tiO <br />vi yORATF ' <br />Secret 's Signature�0� <br />Fgrpp t Seal: <br />J. Mi ael Schaum S <br />Printed Name �'.� .......... <br />DEPARTMENT OF PUBLIC WORKS APPROVAL i,,�NDIt%%, <br />This project is acceptable i*r l approval and we recommend to the Board of Public Works that it be ordaineso. <br />Date: it. 1• 14 <br />Constructi Kmo Hager / <br />/ BOARD OF PUBLIC WO KS APPROVAL Date: <br />Gary A. Gilot, President Suzanna . Fritzber Member Elizabeff A Maradik, Member <br />'Therese J. Dor , Member James A. Mueller, Member -Hhha M. Martin, Clerk <br />