PCA - Lawn Care Services Project No 116-002 A,B, and C - Caretaker Landscape & Lawn

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u i"1 CITY OF SOUTH BEND, INDIANA °Y `; BOARD OF PUBLIC WORKS PROJECT COMPLETION AFFIDAVIT PROJECT NAME PROJECT NO CONTRACT SIGNED PROJECT DESCRIPTION WITNESSETH: The work under the above contract between the City of South Bend and the undersigned contractor having been completed the City of South Bend, its officials and agents are hereby released from all claims and demands whatsoever arising under c by such contract, and that the contractor performed the work within the scope of the Specifications and Standards of the Cit, of South Bend which were a part of the above Contract. this day of 201 Le WITNESSESS: Before me, th undersigned Notary Public in and f, gix4Loe, Ve, 4�kk and acknowledged his/her ,the`,ae4 of day off /L ccy..a n kp.,i201sL .�A. Notary Si bture/ IP Printed Name Caretaker Landscape & Lawn Company Name P.O. Box 324 Company Address Michigan City IN 46360 City, State, Zip La Porte County My Commission Expires January 26, 2024 County of Residence La Po r 1 -e If the Contractor is a corporation, the following certificate will be executed. I. certify that I am Secretary of the Corporation executing this release; that who signed this release on behalf of the contractor was then of said Corporation; that said release was duly signed for and on behalf of said Corporation by Authority of its governing body, and is within the scope of corporate powers: Affidavit on Secretary's Signature Corporate Seal Printed Name DEPARTMENT OF PUBLIC WORKS APPROVAL This is acceptable r final approval and we recommend to the Board of Public Works that it be ordained so. Date: Constructi tanaggr Gary A. Gilot, President Therese J. Dorau, iMerritak BOAR OF PUBLIC WORKS APPRO' SuzannalM. Fritzberg,pember N Ja es A. Mueller, Member