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�I.—% <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS rM rl, <br />PROJECT COMPLETION AFFIDAVIT W <br />PROJECT NAME <br />PROJECT NO <br />CONTRACT SIGNED <br />PROJECT DESCRIPTION <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, its officials and agents are hereby released from all claims and demands whatsoever arising under r <br />by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the Cih <br />of South Bend which were a part of the above Contract. <br />Executed this 2nd da f December . 2p16 _Rieth-Riley Construction CO., INC. <br />Company Name <br />�9 a 252DO State Road 23 <br />Joshua A. Mc ormick, Sales Manager Company Address <br />Printed Name South Bend, Indiana. 46614 <br />City, State, Zip <br />WITNESSESS: <br />Before me, the undersigned Notary Public in and for said country and state, personally appeared <br />Joshua A. McCormick , ar cknowledged his/her signature to the above Project Completion Affidavit on <br />�(rl �,I Gay 'I" <br />Z 70 <br />DAWN E, ARMSTRONG <br />Notary Public, State of Inaiona <br />R, LaPorte count <br />-1761ary Signa'I re My Commission Expires 4/18/23 ? •. sEAI : Commission a 65696 <br />Dawn E. Armstrong NnIANP` y ommiss on Expires <br />'nnn�" April 18, 2023 <br />Printed Name County of Residence LaPorte <br />If the Contractor is a corporation, the following certificate will be executed. <br />I, Gary A. Pyclik certify that I am Secrete of the Cor <br />poration rporatfon executing this release; that <br />Joshua A. McCormick who signed this release on behalf of the contractor was then <br />Sales Manager 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 />A d 3- <br />Secretary's Sig ture <br />Corporate Seal <br />Gary A. Pyclik, A sistant Corporate Secretary <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 ordained so. <br />Date: <br />Constructlol .M nager <br />Gary A. Gilot, President <br />Therese J. Doriu, Member <br />BOARD OF PUBLIC WORDS APPROVAL <br />J' ����� <br />Suzanne M ritzberg, Member <br />Jarr'Ps A. Mueller, Member <br />Date: /.>/.C/� <br />cv . <br />M. Martin, <br />