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PROJECT NAME Je <br />PROJECT NO 11 <br />CONTRACT SIGNED 9/ <br />PROJECT DESCRIPTION <br />WITNESSETH: <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />PROJECT COMPLETION AFFIDAVIT <br />FINAL <br />Blvd between Eddy St. and <br />a center turn lane <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, its officials and agents are hereby released from all claims and demands whatsoever arising under < <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the Cit <br />of South Bend which were a part of the above Contract. <br />this ' daygf W Q\rE MISER 201 (o <br />Name <br />Airmarking Co. Inc. <br />Company Name <br />P.O. Box 526 <br />Company Address <br />Rochester, IN 46975 <br />City, State, Zip <br />WITNESSESS: <br />B fore me, the undersigned Notary Public in and for said country and state, personally appeared <br />�R� r� L OIJE , and acknowledged his/her signature to the above Project Completion Affidavit on <br />the day of 0 Eft 201�. <br />Notary Signatur My Commission Expires SEFEE H ESE <br />14AN L. Pi �E <br />Printed Name County of Residence RLToK <br />If t1A Contractor is a corpn, the following certificate will be executed. <br />1, L. oratiocertify that I am Secretary of the Corporation executing this release; that <br />O L_�who signed this release on behalf of the contractor was then <br />of said Corporation; that said release was duly signed for and on behalf of said <br />Corporation by Auth ity of its overning body, and is within the scope of corporate powers: <br />Q <br />Secretary's Sign re <br />, f Corporate Seal <br />Printed Name t� <br />DEPARTMENT OF PUBLIC WORKS APPROVAL <br />This project is acceptable fo fin I approval and we recommend to the Board of Public Works that it be ordained so. <br />^, Date: l 1- Z- t c <br />Constructior&nager <br />v a BOARD O PUBLIC WORKS APPROVAL Date: /_2 /3 � <br />ZE <br />Gary A. Gilot, President zanna M. berg, Me er Elizabeth A. Maradik, Member <br />Therese J. D ra vlember Ja I <br />s A. Mueller, Member ':Ein' 'a M. Martin, Clerk —IF— <br />