Laserfiche WebLink
CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />PROJECT NAME <br />PROJECT NO. ., l —pa 7 FiNAECOSTdg9, B7'7.0$ <br />CONTRACTSIGNED 3=/q-?O/.6 MAINTENANCE AGREEMENT ENDS <br />PROJECT 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 from 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 of the above Contract. <br />Executed this __L1L_ day of Vlqj� k v✓ 20 1 � <br />Signaturqe //�� Company Name <br />Nail l'a+lY„�G+ SSlbq 6/ 3 A,4, <br />Printed Name Company Address <br />_ EIKA-A 71,% yGs/y <br />City/State/Zip <br />WITNESSES <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />NJ ca4 e- Ca rpert+?' , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the <br />�r} da of MovewiJoe✓,2016 <br />Notary Signature My Commission Expires 4 <br />c*-ie LSieve(S <br />Printed Name County of Residence <br />If the' Contractor is a corporation, the following certificate will be executed. <br />I, NgP, +pe..k✓ , certify that I am Secretary of the Corporation executing this release; that <br />WAh in -a k�✓ who signed this release on behalf of the contractor was then <br />P�FD 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 />k11� <br />Secret ry's Si nahr. <br />Corporate Seal <br />Printed Name <br />DEPARTMENT OF PUBLIC 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. C <br />Date: I I 15 14 <br />Construct' n anager <br />BOARD OF PUBLIC WORKS APPROVAL Date: <br />Gary A. Gr ot, President Suzanna )ff. Fritzber , Meni er <br />James A. Mueller, Member Therese <br />Elizabeth A. Maradik, Member <br />M. Martin, Clerk <br />